Left ventricular free wall rupture after myocardial infarction: Still a challenging complication

Meta‐analysis of surgical treatment for postinfarction left ventricular free‐wall rupture

“…In these patients, it was not possible to verify the proper utility of the VA‐ECMO support because cardiac death happened before starting a weaning protocol. On the other hand, 17.4% of patients who received VA‐ECMO for cardiac arrest at presentation survived to surgery 21 . This study found a clear negative effect of the postoperative VA‐ECMO insertion with an increasing of 2.4‐fold the odds of operative mortality.…”

“…In these patients, it was not possible to verify the proper utility of the VA-ECMO support because cardiac death happened before starting a weaning protocol. On the other hand, 17.4% of patients who received VA-ECMO for cardiac arrest at presentation survived to surgery 21. This study found a clear negative effect of the postoperative VA-ECMO insertion with an increasing of 2.4-fold the odds of operative mortality.However, given the retrospective nature of the study, one can hypothesize that most of patients requiring postoperative VA-ECMO are part of the worst subgroup in terms of extension of myocardial infarction, myocardial tissue damage and irreversible brain damage and in such clinical scenario VA-ECMO institution maybe sometimes considered as compassionate use.…”

“…More recently, collagen sponge patches such as TachoSil® or TachoComb® were described as a valid alternative to patch covering. 7 , 12 , 21 , 22 , 23 These strategies are usually preferred in selected patients, mainly in such conditions were oozing rupture is observed during surgery. Regarding this issue, another study by our group found a significant protective effect of the named “patch and glue” sutureless technique over the sutured technique, previously described.…”

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

“…The rates of perioperative LCOS or multiorgan failure observed in our study and the low rate of aggressive MCS (below 10%) as opposed to less invasive IABP (almost 50%) might indicate a limited use of more effective circulatory assistance. Recent studies have shown an increased use of MCS in this context, 18 suggesting that complicated LVFWR cases, particularly by enhancing LV unloading and peripheral organ perfusion, might benefit from this approach, 19 although dedicated investigations will be warranted to confirm these hypotheses.…”

Ventricular Rupture due to Myocardial Infarction without Obstructive Coronary Artery Disease

“…Overall, the incidence declined significantly over the last decades with emerging primary coronary intervention [ 4 ]. Due to the rapid onset presenting with sudden hypotension, chest pain or cardiac murmurs after 2.6 days on average after acute myocardial infarction lethal outcomes remain still high [ 5 ]. Emergency echocardiography is the diagnostic tool of choice [ 1 ].…”