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Patch-and-glue repair in combination with or without direct suture for cardiac rupture after myocardial infarction
Toshihiro Fujimatsu1, Hajime Oosawa, Fumie Takai
1Department of Cardiovascular Surgery, Heart Center, Aizawa Hospital, 2-5-1 Honjou, Matsumoto, Nagano 390-8510, Japan. sin-dr@ai-hosp.or.jp
Insights
The sutureless patch-and-glue technique for left ventricular free-wall rupture after myocardial infarction offers superior survival rates compared to traditional sutured repairs. This method, utilizing cardioplegic arrest, is preferred for all rupture types.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Myocardial Infarction Management
Background:
- Left ventricular free-wall rupture is a severe complication post-myocardial infarction with controversial surgical management.
- Optimal surgical repair strategies for different types of cardiac rupture are debated.
Purpose of the Study:
- To evaluate the efficacy of a patch-and-glue technique, with or without direct suture, for treating postinfarction cardiac rupture.
- To compare outcomes of different surgical approaches over a 5-year period.
Main Methods:
- Five patients with cardiac rupture (2 blowout, 2 subacute, 1 oozing) were treated using echocardiography for diagnosis.
- Surgical interventions included patch-and-glue with direct suture, infarctectomy, and sutureless patch-and-glue with cardioplegic arrest.
Main Results:
- All patients survived initial treatment; however, mortality was 40% in the direct suture group.
- The sutureless patch-and-glue technique resulted in all three patients surviving and being discharged.
- Long-term follow-up (15-27 months) showed sustained survival in the sutureless group.
Conclusions:
- The sutureless patch-and-glue technique is preferred for all types of left ventricular free-wall rupture, including blowout ruptures.
- Cardioplegic arrest is crucial for creating a bloodless field and enhancing adhesive efficacy.
- Comprehensive coverage of the necrotic area with an appropriately sized patch is essential for successful repair.
Objective:
Left ventricular free-wall rupture is a catastrophic event after myocardial infarction. The most appropriate surgical management remains controversial. We have performed a patch-and-glue technique, with or without direct suture and using cardioplegic arrest, to treat postinfarction cardiac rupture. We describe our experiences over a 5-year period, and discuss the optimal surgical repair for each type of rupture.
Methods:
Since 2002, we have managed 5 patients with cardiac rupture. Two patients had a blowout rupture, 2 were of the subacute type, and 1 experienced an oozing rupture. There were 3 men and 2 women, with an average age of 76.2 +/- 12.5 years. Echocardiography confirmed the diagnosis in all patients. Two patients underwent a patch-and-glue repair in combination with direct suture, one had an infarctectomy, and the others had a completely sutureless patch-and-glue treatment performed using cardioplegic arrest.
Results:
All patients survived the initial treatment and were moved to the intensive care unit with complete hemostasis. The 2 patients who were treated in combination with direct suture died of brain death or cardiac failure (mortality rate 40%). The 3 patients who were treated with the patch-and-glue sutureless technique were discharged from our hospital, and are alive 15-27 months after the operation. Two are doing well, and the other is breathing on his own but remains nonreactive.
Conclusion:
We prefer the patch-and-glue sutureless technique even for a blowout rupture. We performed cardioplegic arrest to provide a bloodless surgical field and maximize adhesive function. The whole necrotic area should be covered with a large patch of appropriate size.
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