Matteo Matteucci1, Mariusz Kowalewski2, Michele De Bonis3, Francesco Formica4, Federica Jiritano5, Dario Fina6, Paolo Meani7, Thierry Folliguet8, Nikolaos Bonaros9, Sandro Sponga10, Piotr Suwalski11, Andrea De Martino12, Theodor Fischlein13, Giovanni Troise14, Guglielmo Actis Dato15, Giuseppe Filiberto Serraino16, Shabir Hussain Shah17, Roberto Scrofani18, Carlo Antona18, Antonio Fiore8, Jurij Matija Kalisnik13, Stefano D'Alessandro19, Emmanuel Villa14, Vittoria Lodo15, Andrea Colli12, Ibrahim Aldobayyan20, Giulio Massimi20, Cinzia Trumello3, Cesare Beghi21, Roberto Lorusso20. 1. Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy. Electronic address: matteomatteucci87@gmail.com. 2. Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland. 3. Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy. 4. Department of Medicine and Surgery, Cardiac Surgery Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Department of Medicine and Surgery, University of Parma, Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy. 5. Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, Catanzaro, Italy. 6. Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy. 7. Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy. 8. Department of Cardio-Thoracic Surgery, University Hospital Henri-Mondor, Créteil, Paris, France. 9. Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria. 10. Cardiothoracic Department, University Hospital of Udine, Udine, Italy. 11. Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland. 12. Section of Cardiac Surgery, University Hospital, Pisa, Italy. 13. Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany. 14. Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy. 15. Cardiac Surgery Department, Mauriziano Hospital, Turin, Italy. 16. Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, Catanzaro, Italy. 17. Cardiovascular and Thoracic Surgery Department, King Fahad Medical City, Riyadh, Saudi Arabia. 18. Cardiac Surgery Unit, Luigi Sacco Hospital, Milan, Italy. 19. Department of Medicine and Surgery, Cardiac Surgery Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy. 20. Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands. 21. Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy.
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.
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.