Postdischarge Complications After Penetrating Cardiac Injury

Abstract

Hypothesis: A significant rate of postdischarge complications is associated with penetrating cardiac injuries. Design: Retrospective trauma registry review. Setting: Level I trauma center. Patients: All patients sustaining penetrating cardiac inju-riesbetweenJanuary2000andJune2010.Patientdemographics, clinical data, operative findings, outpatient follow-up, echocardiogram results, and outcomes were extracted. Main Outcome Measures: Cardiac-related complications and mortality. Results: During the 10.5-year study period, 406 of 40 706 trauma admissions (1.0%) sustained penetrating cardiac injury. One hundred nine (26.9%) survived to hospital discharge. The survivors were predominantly male (94.4%), with a mean (SD) age of 30.8 (11.7) years, and 74.3% sustained a stab wound. Signs of life were present on admission in 92.6%. Cardiac chambers involved were the right ventricle (45.9%), left ventricle (40.3%), right atrium (10.1%), left atrium (0.9%), and combined (2.8%). Inhospital follow-up was available for a mean (SD) of 11.0 (9.8) days (median, 8 days; range, 3-65 days) and outpatient follow-up was available in 46 patients (42.2%) for a mean (SD) of 1.9 (4.1) months (median, 0.9 months; range, 0.2-12 months). Abnormal echocardiograms demonstrated pericardial effusions (9), abnormal wall motion (8), decreased ejection fraction (Ͻ45%) (8), intramural thrombus (4), valve injury (4), cardiac enlargement (2), conduction abnormality (2), pseudoaneurysm (1), aneurysm (1), and septal defect (1). No operative intervention was required for the complications. The 1-year and 9-year survival rates were 97% and 88%, respectively. Conclusions: Penetrating cardiac injuries remain highly lethal. A significant rate of cardiac complications can be expected and follow-up echocardiographic evaluation is warranted prior to discharge. The majority of these, however, can be managed without the need for surgical intervention.

How to mend a broken heart: a major stab wound of the left ventricle

“…The time span taken into consideration, our patient was extremely lucky as the outcome is usually poor when the time from trauma to surgery increases [5,6]. An Israeli study of 14 patients reports 100% survival (9 SW, 2 GSW, 1 shrapnel injury and 1 multi trauma) with the mean time from injury to surgery of 37 min [7].…”

“…Some series present large cohorts of penetrating cardiac injury without use of CPB [3-5]. In case of complex cardiac injuries with multichamber lacerations the advantages of a bloodless and still operating field is obvious [6,20,21].…”

“…Cardiac stabbings might lead to initially unidentified additional injuries which become apparent first several weeks to years later [8,18]. One study with a large series of patients report that these injuries seldom need surgical treatment [5]. There is consensus that echocardiographic assessment should be provided during the hospital stay [5,11].…”

“…One study with a large series of patients report that these injuries seldom need surgical treatment [5]. There is consensus that echocardiographic assessment should be provided during the hospital stay [5,11]. …”

“…Cappelen`s operation is considered to be the first report of a cardiac surgical procedure. Today trauma centers all over the world perform complex cardiac repairs due to penetrating trauma but the mortality is still high [2-5]. …”