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

Matteo Matteucci*, Mariusz Kowalewski, Michele De Bonis, Francesco Formica, Federica Jiritano, Dario Fina, Paolo Meani, Thierry Folliguet, Nikolaos Bonaros, Sandro Sponga, Piotr Suwalski, Andrea De Martino, Theodor Fischlein, Giovanni Troise, Guglielmo Actis Dato, Giuseppe Filiberto Serraino, Shabir Hussain Shah, Roberto Scrofani, Carlo Antona, Antonio FioreJurij Matija Kalisnik, Stefano D'Alessandro, Emmanuel Villa, Vittoria Lodo, Andrea Colli, Ibrahim Aldobayyan, Giulio Massimi, Cinzia Trumello, Cesare Beghi, Roberto Lorusso

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Web of Science)

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 extra-corporeal life support are predictors of early mortality. (C) 2021 by The Society of Thoracic Surgeons. Published by Elsevier Inc.

Original languageEnglish
Pages (from-to)1186-1192
Number of pages7
JournalAnnals of Thoracic Surgery
Volume112
Issue number4
DOIs
Publication statusPublished - Oct 2021

Keywords

  • ELEVATION MYOCARDIAL-INFARCTION
  • CARDIAC RUPTURE
  • MECHANICAL COMPLICATIONS
  • SUTURELESS REPAIR
  • TASK-FORCE
  • MANAGEMENT

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