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Eur J Cardiothorac Surg 2004;26:330-335
© 2004 Elsevier Science NL

Perioperative outcome and long-term survival of surgery for acute post-infarction mitral regurgitation

^a Department of Cardiology and Intensive Care, Hôpital Louis Pradel, 28 Avenue Doyen Lepine, 69394 Lyon cedex 03, France
^b Cardiovascular Surgery Services, Hôpital Louis Pradel, Lyon, France
^c Clinical Pharmacology and Biostatistics Service, Hôpitaux de Lyon, Lyon, France

Received 3 January 2004; received in revised form 23 March 2004; accepted 9 April 2004.

^* Corresponding author. Tel.: +33-472-35-75-49; fax: +33-472-35-73-41
e-mail: philippe.chevalier{at}chu-lyon.fr

Objective: To determine factors predictive of mortality in patients undergoing emergency mitral valve surgery in the setting of severe post-infarction regurgitation. Methods: Patients admitted for an acute myocardial infarction who required urgent mitral valve surgery for severe regurgitation were studied. Factors predictive of outcome were analysed. Results: Fifty-five consecutive patients (mean 65±10 years, 37 males) were included. The infarct was inferior in 31 patients, posterior in 10, anterior in 9 and lateral in 5. Thirty-four patients (62%) were in Killip class IV. Peroperative findings confirmed total papillary muscle rupture in 25 patients (posteromedial in 21, anterolateral in 4), and partial rupture in 12 patients (posteromedial in 10, anterolateral in 2). Papillary muscle dysfunction without rupture was responsible for regurgitation in 18 patients (posteromedial in 15, anterolateral in 3). The mitral valve was replaced by a prosthesis in all but 4 patients, who had valvuloplasty. Coronary angiography was done in 32 patients, of whom 18 underwent concomitant coronary artery bypass grafting and 2 balloon angioplasty. Surgery was performed on average 7 days after infarction. Thirteen patients (24%) died during the perioperative period. Absence of coronary revascularisation was significantly associated with increased perioperative mortality (34% vs. 9%, P=0.02). Of the 42 surviving patients, there were 5 deaths during a mean follow-up of 4.0±3.7 years. Conclusion: In patients with acute post-infarction mitral regurgitation, perioperative mortality is high, but can be improved with concomitant CABG in addition to valve surgery. Long-term outcome of survivors is favourable.

Key Words: Acute myocardial infarction • Mitral regurgitation • Papillary muscle rupture • Mitral replacement • Valvuloplasty • Coronary artery bypass grafting

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