Off-pump external pericardial patch repair for post-infarct left ventricular free wall rupture: a case series
S Mohamed1, K Mazhar1, A J Patel2
1Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke-On-Trent, UK.
Journal of Surgical Case Reports
|March 24, 2021
Summary
This study presents an off-pump surgical technique for left ventricular free wall rupture, a life-threatening complication of heart attack. The external pericardial patch repair shows potential as a bridge to recovery for high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Surgical Innovation
Background:
- Left ventricular (LV) free wall rupture is a rare but catastrophic complication of acute myocardial infarction.
- Cardiac tamponade secondary to LV free wall rupture carries a high mortality rate.
- Existing literature on surgical management of this condition is limited.
Observation:
- Seven patients with acute myocardial infarction and cardiac tamponade due to LV free wall rupture underwent surgical intervention.
- An off-pump surgical technique utilizing an external pericardial patch secured with biological glues was employed.
- The surgical approach aimed to stabilize the rupture and manage the tamponade.
Findings:
- The 30-day mortality rate was 57%, with 1-year and 2-year survival rates at 42%.
- Advanced age, female gender, and the use of cardiopulmonary bypass were not significantly associated with survival outcomes.
- The off-pump external pericardial patch repair demonstrated feasibility in this high-risk patient cohort.
Implications:
- This off-pump surgical strategy may offer a viable 'bridge to recovery' for patients with LV free wall rupture.
- The technique adds to the existing surgical armamentarium for managing this life-threatening cardiac emergency.
- Further research and larger studies are warranted to validate the long-term efficacy and outcomes of this approach.
