Preoperative extracorporeal mechanical circulatory support for patients with acute severe mitral valve regurgitation due to papillary muscle necrosis

Abstract

Background. Acute mitral valve insufficiency has a high mortality rate (up to 100%). Mechanical circulatory support and emergency surgery can improve the survival of this patient cohort.Objectives: to analyze a 12-year single-center experience of treating acute post-infarction mitral valve insufficiency.Materials and methods. This retrospective study included 12 adult patients with ST elevated myocardial infarction (STEMI) and corresponding acute mitral valve insufficiency who underwent surgery between 2009 and 2017. We analyzed the in-hospital period of all patients and long-term follow-ups whenever possible. All patients underwent preoperative coronary angiography and echocardiography. All patients underwent cardiopulmonary bypass and cold-blood cardio- plegia. If venoarterial extracorporeal membrane oxygenation (VA-ECMO) was required, the femoral approach was preferred.Results. Seven patients needed VA-ECMO support, six of them preoperatively; four received mechanical circulatory support outside the hospital. All patients underwent percutaneous coronary intervention (PCI) with successful revascularization of the culprit artery. All but one patient underwent surgery within the first 24 hours. One patient underwent repeat surgery once the mitral valve could be repaired, and the other patient did not require any coronary bypass. In-hospital mortality occurred in one patient in the VA-ECMO group. Patients receiving VA-ECMO had longer duration of inotropic support, ventilation time, and intensive care unit stay (p < 0.01).Conclusions. Acute mitral valve insufficiency due to STEMI remains a dramatic complication, but the perioperative use of VA-ECMO helps reduce 30-day mortality and improve outcomes in this group of patients.

Keywords

• acute mitral regurgitation
• ecmo
• stemi