Predictors of in-hospital mortality after mitral valve surgery for post-myocardial infarction papillary muscle rupture.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
Read More Add to Saved list
  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 101265113 Publication Model: Electronic Cited Medium: Internet ISSN: 1749-8090 (Electronic) Linking ISSN: 17498090 NLM ISO Abbreviation: J Cardiothorac Surg Subsets: MEDLINE
    • Publication Information:
      Original Publication: [London] : BioMed Central, 2006-
    • Subject Terms:
      Decision Support Techniques* ; Hospital Mortality*; Cardiomyopathies/*surgery ; Heart Valve Prosthesis Implantation/*mortality ; Mitral Valve Insufficiency/*surgery ; Myocardial Infarction/*complications ; Papillary Muscles/*surgery; Adult ; Aged ; Aged, 80 and over ; Cardiomyopathies/etiology ; Cardiomyopathies/mortality ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Mitral Valve Insufficiency/etiology ; Mitral Valve Insufficiency/mortality ; ROC Curve ; Retrospective Studies ; Risk Factors ; Rupture, Spontaneous/etiology ; Rupture, Spontaneous/mortality ; Rupture, Spontaneous/surgery ; Treatment Outcome
    • Abstract:
      Background: Papillary muscle rupture (PMR) is a rare, but often life-threatening mechanical complication of myocardial infarction (MI). Immediate surgical intervention is considered the optimal and most rational treatment for acute PMR, but carries high risks. At this point it is not entirely clear which patients are at highest risk. In this study we sought to determine in-hospital mortality and its predictors for patients who underwent mitral valve surgery for post-MI PMR.
      Methods: Between January 1990 and December 2012, 48 consecutive patients (mean age 64.9 ± 10.8 years) underwent mitral valve repair (n = 10) or replacement (n = 38) for post-MI PMR. Clinical data, echocardiographic data, catheterization data, and surgical reports were reviewed. Univariate and multivariate logistic regression analyses were performed to identify predictors of in-hospital mortality.
      Results: Intraoperative mortality was 4.2% and in-hospital mortality was 25.0%. Univariate and multivariate logistic regression analyses revealed the logistic EuroSCORE and EuroSCORE II as independent predictors of in-hospital mortality. Receiver operating characteristics curves showed an optimal cutoff value of 40% for the logistic EuroSCORE (area under the curve 0.85, 95% CI 0.71-1.00, P < 0.001) and of 25% for the EuroSCORE II (area under the curve 0.83, 95% CI 0.68-0.99, P = 0.001). After removal of the EuroSCOREs from the model, complete PMR and intraoperative intra-aortic balloon pump (IABP) requirement were independent predictors of in-hospital mortality.
      Conclusions: The logistic EuroSCORE (optimal cutoff ≥ 40%), EuroSCORE II (optimal cutoff ≥ 25%), complete PMR, and intraoperative IABP requirement are strong independent predictors of in-hospital mortality in patients undergoing mitral valve surgery for post-MI PMR. These predictors may aid in surgical decision making and they may help improve the quality of informed consent.
    • References:
      Eur J Cardiothorac Surg. 2004 Dec;26(6):1112-7. (PMID: 15541971)
      J Heart Valve Dis. 2002 Jan;11(1):20-5; discussion 26. (PMID: 11843502)
      J Card Surg. 1994 Mar;9(2 Suppl):252-4. (PMID: 8186577)
      J Thorac Cardiovasc Surg. 1988 Feb;95(2):165-77. (PMID: 3276968)
      J Heart Valve Dis. 2002 Jan;11(1):27-31. (PMID: 11843503)
      Am Heart J. 2000 Mar;139(3):549-54. (PMID: 10689272)
      Am Heart J. 1966 Mar;71(3):356-62. (PMID: 5905450)
      Eur J Cardiothorac Surg. 2013 Dec;44(6):1063-9. (PMID: 23520228)
      Eur J Cardiothorac Surg. 2004 Aug;26(2):330-5. (PMID: 15296892)
      J Thorac Cardiovasc Surg. 1983 Sep;86(3):323-37. (PMID: 6887954)
      Mayo Clin Proc. 1992 Nov;67(11):1023-30. (PMID: 1434862)
      Dis Chest. 1957 Mar;31(3):316-23. (PMID: 13404913)
      J Am Coll Cardiol. 1986 Sep;8(3):558-65. (PMID: 3745700)
      Circulation. 2008 Oct 7;118(15):1528-34. (PMID: 18809799)
      Ann Thorac Surg. 1990 Jul;50(1):12-26; discussion 27-8. (PMID: 2196014)
      Eur J Cardiothorac Surg. 2012 Apr;41(4):734-44; discussion 744-5. (PMID: 22378855)
      Ann Thorac Cardiovasc Surg. 1998 Apr;4(2):83-6. (PMID: 9577003)
      Ann Thorac Surg. 2013 Mar;95(3):820-4. (PMID: 23219255)
      Ann Intern Med. 1979 Feb;90(2):149-52. (PMID: 443647)
      Am J Cardiol. 1983 Feb;51(3):373-7. (PMID: 6823851)
      Eur J Cardiothorac Surg. 2012 Apr;41(4):746-54. (PMID: 22290922)
      Circulation. 1973 Jun;47(6):1191-6. (PMID: 4350878)
      Circulation. 1965 Oct;32(4):597-601. (PMID: 5826931)
      Biometrics. 1988 Sep;44(3):837-45. (PMID: 3203132)
      Eur J Cardiothorac Surg. 1999 Jul;16(1):9-13. (PMID: 10456395)
    • Publication Date:
      Date Created: 20141018 Date Completed: 20150819 Latest Revision: 20211021
    • Publication Date:
      20240628
    • Accession Number:
      PMC4201923
    • Accession Number:
      10.1186/s13019-014-0171-z
    • Accession Number:
      25322911