TY - JOUR
T1 - Surgical Treatment of Post-Infarction Left Ventricular Free-Wall Rupture
T2 - A Multicenter Study
AU - Matteucci, Matteo
AU - Kowalewski, Mariusz
AU - De Bonis, Michele
AU - Formica, Francesco
AU - Jiritano, Federica
AU - Fina, Dario
AU - Meani, Paolo
AU - Folliguet, Thierry
AU - Bonaros, Nikolaos
AU - Sponga, Sandro
AU - Suwalski, Piotr
AU - De Martino, Andrea
AU - Fischlein, Theodor
AU - Troise, Giovanni
AU - Dato, Guglielmo Actis
AU - Serraino, Giuseppe Filiberto
AU - Shah, Shabir Hussain
AU - Scrofani, Roberto
AU - Antona, Carlo
AU - Fiore, Antonio
AU - Kalisnik, Jurij Matija
AU - D'Alessandro, Stefano
AU - Villa, Emmanuel
AU - Lodo, Vittoria
AU - Colli, Andrea
AU - Aldobayyan, Ibrahim
AU - Massimi, Giulio
AU - Trumello, Cinzia
AU - Beghi, Cesare
AU - Lorusso, Roberto
PY - 2021/10
Y1 - 2021/10
N2 - 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 extra-corporeal life support are predictors of early mortality. (C) 2021 by The Society of Thoracic Surgeons. Published by Elsevier Inc.
AB - 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 extra-corporeal life support are predictors of early mortality. (C) 2021 by The Society of Thoracic Surgeons. Published by Elsevier Inc.
KW - ELEVATION MYOCARDIAL-INFARCTION
KW - CARDIAC RUPTURE
KW - MECHANICAL COMPLICATIONS
KW - SUTURELESS REPAIR
KW - TASK-FORCE
KW - MANAGEMENT
U2 - 10.1016/j.athoracsur.2020.11.019
DO - 10.1016/j.athoracsur.2020.11.019
M3 - Article
C2 - 33307071
SN - 0003-4975
VL - 112
SP - 1186
EP - 1192
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 4
ER -