[Application of transcatheter edge-to-edge repair in the treatment of papillary muscle rupture of mitral valve after acute myocardial infarction].

Objective: To preliminarily investigate the clinical feasibility, early efficacy, and safety of transcatheter edge-to-edge repair (TEER) in patients with acute mitral regurgitation caused by papillary muscle rupture complicating acute myocardial infarction (AMI). Methods: The study is a retrospective case series. A retrospective analysis was conducted on clinical data of 12 patients with AMI complicated by papillary muscle rupture and severe mitral regurgitation who underwent TEER at Xiamen Cardiovascular Hospital affiliated to Xiamen University from December 2021 to October 2024. Collected data included demographic characteristics, diagnostics and treatment processes, in-hospital outcomes data. Procedural success of TEER was defined as successful grasping of the anterior and posterior mitral leaflets and reduction of mitral regurgitation to grade 2+or less. Patients were followed up for 30 days post-procedure to evaluate survival status and the severity of mitral regurgitation. Results: The mean age of the patients was 67.4 years, with 10 males. Eleven patients were diagnosed with ST-segment elevation myocardial infarction, and 11 out of 12 cases involved complete rupture of the posteromedial papillary muscle. Cardiogenic shock was present in 10 patients and the median Society of Thoracic Surgeons score was 51.9%. Procedural success was achieved in all 12 patients, with mitral regurgitation reduced to ≤2+immediately post-procedure. Eleven patients survived to discharge, and no device-or procedure-related complications occurred during the perioperative period. During the follow-up period, 2 patients died and 1 was readmitted for acute heart failure. At the 30-day follow-up, 9 patients maintained a mitral regurgitation grade of ≤2+. Conclusions: TEER is technically feasible for treating acute severe mitral regurgitation caused by papillary muscle rupture following AMI. It can effectively reduce mitral regurgitation and improve hemodynamic status in selected high-risk patients in the short term. However, these findings necessitate further validation through larger-scale multicenter studies and long-term follow-up.