Rescue Transventricular Off-pump Mitral Valve Repair With Artificial Neochords For Acute Mitral Regurgitation Due To Post-infarction Papillary Muscle Rupture

Structured Abstract Objective We report three cases of rescue transventricular off-pump mitral valve (MV) repair in high-risk patients with acute mitral regurgitation (MR) due to post myocardial infarction papillary muscle rupture. Methods Three patients presented with acute inferior STEMI, cardiogenic shock, and pulmonary edema. Preoperative peak Troponin I was 1909 ng/L, 16963 ng/L, and 8299 ng/L, respectively. All patients had successful percutaneous intervention to the culprit coronary artery and antiplatelet therapy was initiated. All patients required inotropic support and had intra-aortic balloon pump inserted preoperatively. Transesophageal echocardiogram demonstrated severe eccentric MR due to the leaflet prolapse secondary to papillary muscle rupture. EuroSCORE II was estimated 16.03%, 16.68%, and 7.81% (STS score of 14.77%, 18.24%, and 9.8%), respectively). The patients underwent urgent transventricular off-pump MV repair using artificial chords Two to three neochords were implanted. Operation duration was less than two hours. Intraoperative and postoperative drainage was minimal in all cases. The MV function was assessed by qualitative and semi-quantitative transesophageal echocardiography. Results Intraoperative MR reduction to mild was achieved in all patients. All patients had moderate MR at discharge likely due to left ventricular remodeling. Severe MR recurred in all patients at 5, 4, and 2 month follow-up, respectively. All patients underwent an elective MV reoperation via conventional approach. Conclusions Off-pump transventricular MV repair may offer a safe and feasible alternative to stabilize high-risk patients with acute MR due to post-infarction papillary muscle rupture. Although early MR recurrence is concerning, urgent transventricular MV repair may serve as a bridge to conventional surgery in such unstable patients.