Post-infarction left ventricular free wall rupture: 12-years experience from the Cardiac Centre of the Institute of Clinical and Experimental Medicine in Prague, Czech Republic

Abstract

Background. Post-infarction left ventricular free wall rupture (LVFWR) is a feared and catastrophic complication of myocardial infarction that carries a high surgical and hospital mortality. Due to the rarity of this complication, little information exists on surgical treatment and outcomes. Goal and Methods. The goal of this study was to present our experience with LVFWR. We present a retrospective cohort of 19 consecutive patients who were surgically treated in the Cardiac Centre of the Institute of Clinical and Experimental Medicine in Prague between January 2006 and December 2017. Results. Thirty-day mortality was 26%. Five patients died. Four patients died in the operating theatre and one patient on the ninth postoperative day following re-rupture. Seventy-four percent of the patient cohort survived and were discharged from hospital. The median length of follow-up was 45 months (range 0.75-150). No patient died during follow-up. Median postoperative ejection fraction was 45% (range 25-65%). Angina pectoris and dyspnea were investigated during follow-up and graded according to the Canadian cardiology society (CCS) and the New York Heart Association (NYHA) classifications. Fourteen patients had CCS class I, eight patients had NYHA class I dyspnea and six patients had NYHA class II. Re-rupture occurred after hospital discharge in one patient one month after the original surgery. The patient was treated successfully by urgent surgical intervention. Conclusion. LVFWR is a catastrophic and challenging complication of myocardial infarction. Good outcomes can be achieved by rapid diagnosis and urgent surgical intervention as shown by our results.

Surgical repair of post-infarction ventricular free-wall rupture in the Netherlands: data from a nationwide registry

“…However, our results did not show any benefit of intraoperative MCS insertion for in-hospital survival. Such a result may be explained by many factors, including the low adoption rate (n=5) We observed a high in-hospital mortality rate (almost one-third of the total patient population), which is consistent with the 17-34% operative mortality rate reported in the literature (4,5,(17)(18)(19). In the present study, female sex was a strong independent predictor for unfavorable in-hospital outcome.…”

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

“…The study selection process and reasons for exclusion are described in Figure S1 . After removal of articles not pertinent to the design of the current study, 11 reports 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 with suitable data were included in the final meta‐analysis. All selected papers were published after 2001.…”

“…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. Although the indications for VA-ECMO support are widely recognized, as well as the weaning and management strategies, in this meta-analysis it was not possible to identify the appropriate indications for the use of VA-ECMO in the postoperative period for two main reasons: first, few patients (26/363, 11%) received postoperative VA-ECMO support and of these it was not possible to identify exactly the causes determining the need for the mechanical support besides the CPB weaning failure; second, none of the four studies(10,11,13,14) that reported the postoperative VA-ECMO implant have focused on the indications and management strategies such as weaning due to myocardial recovery, bridging to the heart transplant or to long-term left ventricular assist device. Further studies are needed to address this issue thoroughly.…”

Surgical management for mechanical complications of acute myocardial infarction: a systematic review of long-term outcomes

“…Our review identified five original studies with long-term outcome data for surgically managed FWR (Table 1) (20)(21)(22)(23)(24) Operative mortality among the studies ranged from 12-34%. In the study by Okamura et al, overall survival of 35 patients managed with sutureless repair without the use of CPB at 1, 5, and 10 years was 71.4%, 68.6%, and 62.9%, respectively.…”