With an approximate incidence of 0.05% to 0.25%, post-acute myocardial infarction (AMI) mitral valve failure caused by papillary muscle rupture is not exactly common. However, it is associated to high mortality rate, ranging between 36% and 80%.
Current guidelines recommend surgical treatment, but more often than not surgery involves prohibitive or extremely high risk, with mortality ranging between 21% and 53%, according to the available reports.
Edge-to-edge repair has been shown safe, effective and beneficial, and could be considered a viable strategy in this scenario. However, there is little information about it.
This study looked at 22 patients presenting complicated AMI with papillary muscle rupture, 17 of these caused by ST elevation MI.
Mean patient age was 74, 13 were men, 10 saw complete papillary muscle rupture and 15 were affected in their posteromedial muscle. 19 presented cardiogenic shock, 3 developed acute lung edema, 16 received inotropics and they were all using ventricular assisting devices.
MitraClip implantation was successful in all patients, and 17 of them received 2 clips. No patient presented moderate to severe mitral valve regurgitation (MR) and there was average residual gradient 3.7 mmHg.
During hospital stay, 4 patients died (2 because of sepsis and 2 for cardiac failure) and one patient suffered a stroke.
14 patients were followed up for mean 2.5 months (from 1 to 6 months) During this time, 2 patients died and 2 presented moderate MR, but no patient developed severe MR.
Conclusion
This analysis has shown edge-to-edge repair is safe and effective for post-AMI mitral regurgitation management. This series of cases informs a significant reduction in MR severity, with relatively low inhospital death and a low rate of complications. Long term outcome assessment calls for further dedicated studies.
Dr. Carlos Fava.
Member of the editorial board of SOLACI.org.
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