Operative strategies for acute mitral regurgitation as a mechanical complication of myocardial infarction

Abstract

Severe mitral regurgitation secondary to papillary muscle rupture is one of the mechanical complications after an acute myocardial infarction. Surgical strategies represent the cornerstone of treatment in this disease; in addition to surgical valve replacement, approaches involving surgical valve repair have been reported over time in different clinical scenarios to restore valve competency, improve cardiac function and reduce mechanical prosthesis-related risks. Moreover, in recent years, percutaneous trans-catheter procedures have emerged as an important alternative in high risk or inoperable patients.

Extracorporeal life support in mitral papillary muscle rupture: Outcome of multicenter study

“…course, particularly by low cardiac output syndrome. 15 It is, therefore, likely that even if surgery remains the cornerstone of treatment for patients with PMR, a more aggressive use of MCS might be taken into timely consideration. V-A ECLS, or alternative temporary cardiocirculatory assist devices, may constitute a safe bridging to operative room as soon as hemodynamic stability is obtained, or enhance the patient management in the perioperative phase which is usually characterized by critical cardio-circulatory conditions secondary to the AMI and subsequent surgery.…”

“…The precarious hemodynamic state in post-AMI PMR patients, and the difficult reconstruction of the MV due to infarcted and compromised PM, often translates into a MVR as the procedure of choice in order to reduce the aortic clamping times, duration of the CPB support, and its related effects. 15 Percutaneous catheter-based treatment has been recently proposed as a bridge-to-surgery management or even as an alternative in inoperable patients.…”

“…Due to the high risk of a worsen evolution to cardiogenic shock and subsequent multi‐organ failure as well as possible death, an early diagnosis and a timely treatment are extremely important in post‐AMI PMR patients. However, we recently highlighted that even if surgery is promptly performed, in‐hospital mortality of PMR patients undergoing surgery remains high, most likely due to poor preoperative cardio‐circulatory and respiratory conditions or complicated postoperative course, particularly by low cardiac output syndrome 15 . It is, therefore, likely that even if surgery remains the cornerstone of treatment for patients with PMR, a more aggressive use of MCS might be taken into timely consideration.…”

“…V‐A ECLS, or alternative temporary cardio‐circulatory assist devices, may constitute a safe bridging to operative room as soon as hemodynamic stability is obtained, or enhance the patient management in the perioperative phase which is usually characterized by critical cardio‐circulatory conditions secondary to the AMI and subsequent surgery. The precarious hemodynamic state in post‐AMI PMR patients, and the difficult reconstruction of the MV due to infarcted and compromised PM, often translates into a MVR as the procedure of choice in order to reduce the aortic clamping times, duration of the CPB support, and its related effects 15 . Percutaneous catheter‐based treatment has been recently proposed as a bridge‐to‐surgery management or even as an alternative in inoperable patients.…”