Background: Left ventricular free-wall rupture (LVFWR) is an uncommon but serious mechanical complication of acute myocardial infarction. Surgical repair, though challenging, is the only definitive treatment. Given the rarity of this condition, however, results after surgery are still not well established. The aim of this study was to review a multicenter experience with the surgical management of post-infarction LVFWR and analyze the associated early outcomes. Methods: Using the CAUTION (Mechanical Complications of Acute Myocardial Infarction: an International Multicenter Cohort Study) database, we identified 140 patients who were surgically treated for post–acute myocardial infarction LVFWR in 15 different centers from 2001 to 2018. The main outcome measured was operative mortality. Multivariate analysis was carried out by constructing a logistic regression model to identify predictors of postoperative mortality. Results: The mean age of patients was 69.4 years. The oozing type of LVFWR was observed in 79 patients (56.4%), and the blowout type in 61 (43.6%). Sutured repair was used in the 61.4% of cases. The operative mortality rate was 36.4%. Low cardiac output syndrome was the main cause of perioperative death. Myocardial rerupture after surgery occurred in 10 patients (7.1%). Multivariable analysis revealed that preoperative left ventricular ejection fraction (P <.001), cardiac arrest at presentation (P =.011), female sex (P =.044), and the need for preoperative extracorporeal life support (P =.003) were independent predictors for operative mortality. Conclusions: Surgical repair of post-infarction LVFWR carries a high operative mortality. Female sex, preoperative left ventricular ejection fraction, cardiac arrest, and extracorporeal life support are predictors of early mortality.

Surgical Treatment of Post-Infarction Left Ventricular Free-Wall Rupture: A Multicenter Study / M. Matteucci, M. Kowalewski, M. De Bonis, F. Formica, F. Jiritano, D. Fina, P. Meani, T. Folliguet, N. Bonaros, S. Sponga, P. Suwalski, A. De Martino, T. Fischlein, G. Troise, G.A. Dato, G.F. Serraino, S.H. Shah, R. Scrofani, C. Antona, A. Fiore, J.M. Kalisnik, S. D'Alessandro, E. Villa, V. Lodo, A. Colli, I. Aldobayyan, G. Massimi, C. Trumello, C. Beghi, R. Lorusso. - In: ANNALS OF THORACIC SURGERY. - ISSN 0003-4975. - 112:4(2021), pp. 1186-1192. [10.1016/j.athoracsur.2020.11.019]

Surgical Treatment of Post-Infarction Left Ventricular Free-Wall Rupture: A Multicenter Study

D. Fina;P. Meani;A. De Martino;R. Scrofani;C. Antona;A. Colli;
2021

Abstract

Background: Left ventricular free-wall rupture (LVFWR) is an uncommon but serious mechanical complication of acute myocardial infarction. Surgical repair, though challenging, is the only definitive treatment. Given the rarity of this condition, however, results after surgery are still not well established. The aim of this study was to review a multicenter experience with the surgical management of post-infarction LVFWR and analyze the associated early outcomes. Methods: Using the CAUTION (Mechanical Complications of Acute Myocardial Infarction: an International Multicenter Cohort Study) database, we identified 140 patients who were surgically treated for post–acute myocardial infarction LVFWR in 15 different centers from 2001 to 2018. The main outcome measured was operative mortality. Multivariate analysis was carried out by constructing a logistic regression model to identify predictors of postoperative mortality. Results: The mean age of patients was 69.4 years. The oozing type of LVFWR was observed in 79 patients (56.4%), and the blowout type in 61 (43.6%). Sutured repair was used in the 61.4% of cases. The operative mortality rate was 36.4%. Low cardiac output syndrome was the main cause of perioperative death. Myocardial rerupture after surgery occurred in 10 patients (7.1%). Multivariable analysis revealed that preoperative left ventricular ejection fraction (P <.001), cardiac arrest at presentation (P =.011), female sex (P =.044), and the need for preoperative extracorporeal life support (P =.003) were independent predictors for operative mortality. Conclusions: Surgical repair of post-infarction LVFWR carries a high operative mortality. Female sex, preoperative left ventricular ejection fraction, cardiac arrest, and extracorporeal life support are predictors of early mortality.
Aged; Aged, 80 and over; Female; Heart Rupture; Heart Rupture, Post-Infarction; Heart Ventricles; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome
Settore MED/23 - Chirurgia Cardiaca
9-dic-2020
Article (author)
File in questo prodotto:
File Dimensione Formato  
1-s2.0-S0003497520320956-main.pdf

accesso aperto

Tipologia: Publisher's version/PDF
Dimensione 287.23 kB
Formato Adobe PDF
287.23 kB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/904583
Citazioni
  • ???jsp.display-item.citation.pmc??? 1
  • Scopus 10
  • ???jsp.display-item.citation.isi??? 10
social impact