open access

Vol 29, No 4 (2022)
Review Article
Submitted: 2021-07-26
Accepted: 2022-05-10
Published online: 2022-05-24
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Overview of mitral valve replacement versus mitral valve repair due to ischemic papillary muscle rupture: A meta-analysis inspired by a case report

Barbara Pala1, Antonella Romaniello2, Ernesto Cristiano1, Adriano D'Angelo1, Maria Chiara Grimaldi1, Ilaria Figliuzzi1, Euclide Tonelli3, Massimo Volpe1
DOI: 10.5603/CJ.a2022.0046
·
Pubmed: 35621090
·
Cardiol J 2022;29(4):680-690.
Affiliations
  1. Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
  2. Division of Cardiology, Sant’ Andrea Hospital, Sapienza University of Rome, Rome, Italy
  3. Department of Cardiac Surgery, Sant ’Andrea Hospital, Sapienza University of Rome, Rome, Italy

open access

Vol 29, No 4 (2022)
Review articles — Clinical cardiology
Submitted: 2021-07-26
Accepted: 2022-05-10
Published online: 2022-05-24

Abstract

Background: Papillary muscle rupture (PMR) is an infrequent but catastrophic complication after myocardial infarction (MI). Surgical procedure is considered the optimal treatment, despite high risk. However, the gold standard technique is still a major dilemma. Therefore, a meta-analysis was carried out to assess and provide an overview comparing mitral valve replacement (MVR) and mitral valve repair (MVr) for PMR post-MI. Methods: A systematic literature search was performed. Data were extracted and verified using a standardized data extraction form. Meta-analysis was realized mainly using RevMan 5.4 software. Results: From four observational studies 1640 patients were identified; 81% underwent MVR and 19% MVr. Operative mortality results were significantly higher in MVR group than the MVr group. MVR was performed under emergency conditions and patients admitted in cardiogenic shock or who required the use of mechanical cardiac support underwent MVR. MVr had shorter time of hospitalization and similar incidence of postoperative complications than MVR. No significant differences existed between the two procedures regarding cardiopulmonary bypass time. Conclusions: Mitral valve repair appears to be a viable alternative to MVR for post-MI PMR, given that it has lower operative mortality, shorter time of hospitalization and similar incidence of short-term postoperative complications than MVR. However, it needs to be pointed out that MVR was associated with the most critical clinical condition following PMR. There is uncertainty regarding the overall survival and improvement of the quality of life between the procedures. Nevertheless, further completed investigation is required.

Abstract

Background: Papillary muscle rupture (PMR) is an infrequent but catastrophic complication after myocardial infarction (MI). Surgical procedure is considered the optimal treatment, despite high risk. However, the gold standard technique is still a major dilemma. Therefore, a meta-analysis was carried out to assess and provide an overview comparing mitral valve replacement (MVR) and mitral valve repair (MVr) for PMR post-MI. Methods: A systematic literature search was performed. Data were extracted and verified using a standardized data extraction form. Meta-analysis was realized mainly using RevMan 5.4 software. Results: From four observational studies 1640 patients were identified; 81% underwent MVR and 19% MVr. Operative mortality results were significantly higher in MVR group than the MVr group. MVR was performed under emergency conditions and patients admitted in cardiogenic shock or who required the use of mechanical cardiac support underwent MVR. MVr had shorter time of hospitalization and similar incidence of postoperative complications than MVR. No significant differences existed between the two procedures regarding cardiopulmonary bypass time. Conclusions: Mitral valve repair appears to be a viable alternative to MVR for post-MI PMR, given that it has lower operative mortality, shorter time of hospitalization and similar incidence of short-term postoperative complications than MVR. However, it needs to be pointed out that MVR was associated with the most critical clinical condition following PMR. There is uncertainty regarding the overall survival and improvement of the quality of life between the procedures. Nevertheless, further completed investigation is required.

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Keywords

ischemic papillary muscle rupture, mitral valve repair, mitral valve replacement, meta-analysis

About this article
Title

Overview of mitral valve replacement versus mitral valve repair due to ischemic papillary muscle rupture: A meta-analysis inspired by a case report

Journal

Cardiology Journal

Issue

Vol 29, No 4 (2022)

Article type

Review Article

Pages

680-690

Published online

2022-05-24

Page views

2395

Article views/downloads

380

DOI

10.5603/CJ.a2022.0046

Pubmed

35621090

Bibliographic record

Cardiol J 2022;29(4):680-690.

Keywords

ischemic papillary muscle rupture
mitral valve repair
mitral valve replacement
meta-analysis

Authors

Barbara Pala
Antonella Romaniello
Ernesto Cristiano
Adriano D'Angelo
Maria Chiara Grimaldi
Ilaria Figliuzzi
Euclide Tonelli
Massimo Volpe

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