Surgical repair of left ventricular free-wall rupture complicating acute myocardial infarction: a single-center 30 years of experience
BackgroundLeft ventricular free-wall rupture (LVFWR) is a catastrophic complication of acute myocardial infarction (AMI). Historically, cardiac surgery is considered the treatment of choice. However, because of the rarity of this entity, little is known regarding the efficacy and safety of surgical...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-01-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1348981/full |
| _version_ | 1797359970973384704 |
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| author | Matteo Matteucci Matteo Matteucci Matteo Matteucci Sandro Ferrarese Vittorio Mantovani Claudio Corazzari Giangiuseppe Cappabianca Corinne Messina Sara Garis Paolo Severgnini Roberto Lorusso Andrea Musazzi |
| author_facet | Matteo Matteucci Matteo Matteucci Matteo Matteucci Sandro Ferrarese Vittorio Mantovani Claudio Corazzari Giangiuseppe Cappabianca Corinne Messina Sara Garis Paolo Severgnini Roberto Lorusso Andrea Musazzi |
| author_sort | Matteo Matteucci |
| collection | DOAJ |
| description | BackgroundLeft ventricular free-wall rupture (LVFWR) is a catastrophic complication of acute myocardial infarction (AMI). Historically, cardiac surgery is considered the treatment of choice. However, because of the rarity of this entity, little is known regarding the efficacy and safety of surgical treatment for post-infarction LVFWR. The aim of this study was to report a single-center experience in this field over a period of 30 years.MethodsPatients who developed LVFWR following AMI and underwent surgical repair at our Institution from January 1990 to December 2019 were considered. The primary end-point was in-hospital morality rate; secondary outcomes were long-term survival and postoperative complications. Multivariate analysis was carried out by constructing a logistic regression model to identify risk factors for early mortality.ResultsA total of 35 patients were enrolled in this study. The mean age was 68.9 years; 65.7% were male. The oozing type of LVFWR was encountered in 29 individuals, and the blowout type in 6 subjects. Sutured repair was used in 77.1% of patients, and sutureless repair in the remaining cases. The in-hospital mortality rate was 28.6%. Low cardiac output syndrome was the main cause of postoperative death. Multivariable analysis identified age >75 years at operation, preoperative cardiac arrest, concurrent ventricular septal rupture (VSR) as independent predictors of in-hospital death. Follow-up was complete in 100% of patients who survived surgery (mean follow-up: 9.3 ± 7.8 years); among the survivors, 16 patients died during the follow-up with a 3-year and 12-year overall survival rate of 82.5% and 55.2%, respectively.ConclusionsSurgical treatment of LVFWR following AMI is possible with acceptable in-hospital mortality and excellent long-term results. Advanced age, concurrent VSR and cardiac arrest at presentation are independent risk factors of poor early outcome. |
| first_indexed | 2024-03-08T15:31:38Z |
| format | Article |
| id | doaj.art-717959d78cdb4fa3a3fc3cdedf85c68d |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-03-08T15:31:38Z |
| publishDate | 2024-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-717959d78cdb4fa3a3fc3cdedf85c68d2024-01-10T04:25:20ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2024-01-011010.3389/fcvm.2023.13489811348981Surgical repair of left ventricular free-wall rupture complicating acute myocardial infarction: a single-center 30 years of experienceMatteo Matteucci0Matteo Matteucci1Matteo Matteucci2Sandro Ferrarese3Vittorio Mantovani4Claudio Corazzari5Giangiuseppe Cappabianca6Corinne Messina7Sara Garis8Paolo Severgnini9Roberto Lorusso10Andrea Musazzi11Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, NetherlandsCardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, ItalyDepartment of Biotechnology and Life Sciences, University of Insubria, Varese, ItalyCardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, ItalyCardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, ItalyCardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, ItalyCardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, ItalyCardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, ItalyCardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, ItalyDepartment of Biotechnology and Life Sciences, University of Insubria, Varese, ItalyDepartment of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, NetherlandsCardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, ItalyBackgroundLeft ventricular free-wall rupture (LVFWR) is a catastrophic complication of acute myocardial infarction (AMI). Historically, cardiac surgery is considered the treatment of choice. However, because of the rarity of this entity, little is known regarding the efficacy and safety of surgical treatment for post-infarction LVFWR. The aim of this study was to report a single-center experience in this field over a period of 30 years.MethodsPatients who developed LVFWR following AMI and underwent surgical repair at our Institution from January 1990 to December 2019 were considered. The primary end-point was in-hospital morality rate; secondary outcomes were long-term survival and postoperative complications. Multivariate analysis was carried out by constructing a logistic regression model to identify risk factors for early mortality.ResultsA total of 35 patients were enrolled in this study. The mean age was 68.9 years; 65.7% were male. The oozing type of LVFWR was encountered in 29 individuals, and the blowout type in 6 subjects. Sutured repair was used in 77.1% of patients, and sutureless repair in the remaining cases. The in-hospital mortality rate was 28.6%. Low cardiac output syndrome was the main cause of postoperative death. Multivariable analysis identified age >75 years at operation, preoperative cardiac arrest, concurrent ventricular septal rupture (VSR) as independent predictors of in-hospital death. Follow-up was complete in 100% of patients who survived surgery (mean follow-up: 9.3 ± 7.8 years); among the survivors, 16 patients died during the follow-up with a 3-year and 12-year overall survival rate of 82.5% and 55.2%, respectively.ConclusionsSurgical treatment of LVFWR following AMI is possible with acceptable in-hospital mortality and excellent long-term results. Advanced age, concurrent VSR and cardiac arrest at presentation are independent risk factors of poor early outcome.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1348981/fullleft ventricular free-wall ruptureacute myocardial infarctionsurgical repairmechanical complicationscardiac rupture |
| spellingShingle | Matteo Matteucci Matteo Matteucci Matteo Matteucci Sandro Ferrarese Vittorio Mantovani Claudio Corazzari Giangiuseppe Cappabianca Corinne Messina Sara Garis Paolo Severgnini Roberto Lorusso Andrea Musazzi Surgical repair of left ventricular free-wall rupture complicating acute myocardial infarction: a single-center 30 years of experience Frontiers in Cardiovascular Medicine left ventricular free-wall rupture acute myocardial infarction surgical repair mechanical complications cardiac rupture |
| title | Surgical repair of left ventricular free-wall rupture complicating acute myocardial infarction: a single-center 30 years of experience |
| title_full | Surgical repair of left ventricular free-wall rupture complicating acute myocardial infarction: a single-center 30 years of experience |
| title_fullStr | Surgical repair of left ventricular free-wall rupture complicating acute myocardial infarction: a single-center 30 years of experience |
| title_full_unstemmed | Surgical repair of left ventricular free-wall rupture complicating acute myocardial infarction: a single-center 30 years of experience |
| title_short | Surgical repair of left ventricular free-wall rupture complicating acute myocardial infarction: a single-center 30 years of experience |
| title_sort | surgical repair of left ventricular free wall rupture complicating acute myocardial infarction a single center 30 years of experience |
| topic | left ventricular free-wall rupture acute myocardial infarction surgical repair mechanical complications cardiac rupture |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1348981/full |
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