Abstract Body (Do not enter title and authors here): Background:
Papillary muscle rupture (PMR) is a devastating mechanical complication of acute myocardial infarction and carries a high mortality for which the current definitive treatment is urgent mitral valve replacement (MVR). However, in select high-risk surgical candidates, transcatheter mitral valve repair using MitraClip has emerged as a viable alternative. This study evaluates the contemporary utilization of MitraClip versus MVR for PMR and compares outcomes including in-hospital mortality, length of stay (LOS), comorbidity burden, and healthcare costs.
Methodology:
Using the 2021 national inpatient sample database which is a survey weighted sample representative of the entire US population consisting of over 6 million observations we identified patients who had papillary muscle rupture and underwent either MitraClip vs MVR using ICD10 procedure codes. Primary outcomes included in-hospital mortality, LOS, and hospitalization cost. Comorbidity burden was assessed using the Charlson Comorbidity Index (CCI).
Results:
A total of 524 patients were identified with PMR. Of these, 90.74% underwent MVR, while 9.25% received MitraClip. Sex distribution was similar between the two groups. The mean age for MItraClip was significantly higher (72y vs 61.9y). Although the all-cause Inpatient mortality was higher for MItraClip (20% vs 18.36%), the difference was not statistically significant (p=0.90). Patients with MItraclip had higher comorbidity burden with charlson index (4.8 vs 2.7). MItraClip was associated with a shorter mean LOS (10.4 vs 17.8 days) and lower mean hospitalization costs ($328,296 vs $662,903).
Conclusion:
Mitral valve replacement remains the predominant treatment strategy for PMR. However, MitraClip is utilized in nearly 10% of cases, primarily in older, more comorbid patients. Despite a higher comorbidity index, MitraClip was not associated with increased inpatient mortality and was linked to shorter hospital stays and reduced healthcare costs. These findings support the selective use of MitraClip as a feasible alternative in high-risk patients with PMR.