Surgical Management of Acute Mitral Valve Regurgitation due to Post-infarction Papillary Muscle Rupture
Reza Tavakoli MD, Alberto Weber MD, Paul Vogt MD, Hans-Peter Brunner MD, Rene Pretre MD, Marko Turina MD

Between January and December 1988, 21 consecutive patients (mean age 62 ± 9.7 years) underwent emergency coronary and concomitant mitral valve surgery for acute myocardial infarction and mitral papillary muscle rupture associated with cardiogenic shock. Preoperatively, intra-aortic balloon pumping was used in 11 patients. Mitral valve replacement was performed in 19 patients (90%) and mitral valve repair in two (10%). An average of 2.2 distal anastomoses per patient was performed. Revascularization was complete in 90% of patients (19/21). Thirty-day mortality was 19% (4/21), with two cardiac-related early deaths (10%). There were three late deaths (one cardiac-related). Actuarial survival at one, five and 10 years was 81, 68 and 56%, respectively. All survivors were in NYHA class I or II. Emergency surgery for acute post-infarction mitral papillary muscle rupture is justified, even as a salvage procedure. Concomitant mitral valve surgery and complete coronary artery revascularization achieve acceptable survival rates and satisfactory functional results.