Postinfarction left ventricular free wall rupture: A 17-year single-centre experience

Francesco Formica, Serena Mariani, Gurmeet Singh, Stefano D'Alessandro, Luigi AmerigoMessina, Norman Jones, Oluwaseun Adebayo Bamodu, Fabio Sangalli, Giovanni Paolini

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

OBJECTIVES: Left ventricular free wall rupture (LVFWR) is a catastrophic complication following acute myocardial infarction with an estimated incidence of 0.2-7.6% and mortality can be as high as 60%. This study aimed to identify the risk factors for morbidity and mortality in patients affected by LVFWR. METHODS: This is a retrospective study of 35 patients who underwent surgery for LVFWR between January 2000 and December 2016 at our institution. RESULTS: The mean age of patients was 68.3 years. The in-hospital survival was 65.7% (n = 23), and 13% of survived patients presented with cardiac arrest. The following characteristics were associated with in-hospital mortality at univariable analysis: pre-existing hypertension (P = 0.02), need for inotropes (P = 0.02) and cardiac arrest (P < 0.0001) at presentation, cardiopulmonary resuscitation (P = 0.004), preoperative extracorporeal membrane oxygenation (P = 0.004), technique of LVFWR repair (P = 0.013), operation on extracorporeal membrane oxygenation (P = 0.005) and postoperative extracorporeal membrane oxygenation (P = 0.001). In the multivariable analysis, cardiac arrest at presentation was an independent predictor of in-hospital mortality (odds ratio 11.7, 95% confidence interval 2.352-59.063; P = 0.003). The overall mean postoperative follow-up was 8.3 ± 1.3 years. Overall survival rates at 5 and 10 years were 53.2 ± 8.6% and 49.1 ± 8.9%, respectively. Among the survivors, only 6 (26.1%) patients died during follow-up with a 5-year and 10-year overall survival rate of 80.9 ± 8.7% and 74.7 ± 10%, respectively. CONCLUSIONS: These data suggest a trend towards long-term benefit in patients surviving high-risk surgery for LVFWR repair. Considering the high lethality of LVFWR, the urgency and complexity of the primary surgical intervention early diagnosis and prompt surgery play a key role in the management of this complication.

Original languageEnglish
Pages (from-to)150-156
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume53
Issue number1
DOIs
Publication statusPublished - Jan 1 2018

Fingerprint

Heart Rupture
A 17
Extracorporeal Membrane Oxygenation
Heart Arrest
Hospital Mortality
Survival Rate
Prehypertension
Mortality
Cardiopulmonary Resuscitation
Survivors
Early Diagnosis
Retrospective Studies
Odds Ratio
Myocardial Infarction
Confidence Intervals
Morbidity
Survival
Incidence

Keywords

  • Acute myocardial infarction
  • Cardiogenic shock
  • Extracorporeal membrane oxygenation
  • In hospital survival
  • Ventricular wall

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Formica, F., Mariani, S., Singh, G., D'Alessandro, S., AmerigoMessina, L., Jones, N., ... Paolini, G. (2018). Postinfarction left ventricular free wall rupture: A 17-year single-centre experience. European Journal of Cardio-thoracic Surgery, 53(1), 150-156. https://doi.org/10.1093/ejcts/ezx271

Postinfarction left ventricular free wall rupture : A 17-year single-centre experience. / Formica, Francesco; Mariani, Serena; Singh, Gurmeet; D'Alessandro, Stefano; AmerigoMessina, Luigi; Jones, Norman; Bamodu, Oluwaseun Adebayo; Sangalli, Fabio; Paolini, Giovanni.

In: European Journal of Cardio-thoracic Surgery, Vol. 53, No. 1, 01.01.2018, p. 150-156.

Research output: Contribution to journalArticle

Formica, F, Mariani, S, Singh, G, D'Alessandro, S, AmerigoMessina, L, Jones, N, Bamodu, OA, Sangalli, F & Paolini, G 2018, 'Postinfarction left ventricular free wall rupture: A 17-year single-centre experience', European Journal of Cardio-thoracic Surgery, vol. 53, no. 1, pp. 150-156. https://doi.org/10.1093/ejcts/ezx271
Formica F, Mariani S, Singh G, D'Alessandro S, AmerigoMessina L, Jones N et al. Postinfarction left ventricular free wall rupture: A 17-year single-centre experience. European Journal of Cardio-thoracic Surgery. 2018 Jan 1;53(1):150-156. https://doi.org/10.1093/ejcts/ezx271
Formica, Francesco ; Mariani, Serena ; Singh, Gurmeet ; D'Alessandro, Stefano ; AmerigoMessina, Luigi ; Jones, Norman ; Bamodu, Oluwaseun Adebayo ; Sangalli, Fabio ; Paolini, Giovanni. / Postinfarction left ventricular free wall rupture : A 17-year single-centre experience. In: European Journal of Cardio-thoracic Surgery. 2018 ; Vol. 53, No. 1. pp. 150-156.
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T2 - A 17-year single-centre experience

AU - Formica, Francesco

AU - Mariani, Serena

AU - Singh, Gurmeet

AU - D'Alessandro, Stefano

AU - AmerigoMessina, Luigi

AU - Jones, Norman

AU - Bamodu, Oluwaseun Adebayo

AU - Sangalli, Fabio

AU - Paolini, Giovanni

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N2 - OBJECTIVES: Left ventricular free wall rupture (LVFWR) is a catastrophic complication following acute myocardial infarction with an estimated incidence of 0.2-7.6% and mortality can be as high as 60%. This study aimed to identify the risk factors for morbidity and mortality in patients affected by LVFWR. METHODS: This is a retrospective study of 35 patients who underwent surgery for LVFWR between January 2000 and December 2016 at our institution. RESULTS: The mean age of patients was 68.3 years. The in-hospital survival was 65.7% (n = 23), and 13% of survived patients presented with cardiac arrest. The following characteristics were associated with in-hospital mortality at univariable analysis: pre-existing hypertension (P = 0.02), need for inotropes (P = 0.02) and cardiac arrest (P < 0.0001) at presentation, cardiopulmonary resuscitation (P = 0.004), preoperative extracorporeal membrane oxygenation (P = 0.004), technique of LVFWR repair (P = 0.013), operation on extracorporeal membrane oxygenation (P = 0.005) and postoperative extracorporeal membrane oxygenation (P = 0.001). In the multivariable analysis, cardiac arrest at presentation was an independent predictor of in-hospital mortality (odds ratio 11.7, 95% confidence interval 2.352-59.063; P = 0.003). The overall mean postoperative follow-up was 8.3 ± 1.3 years. Overall survival rates at 5 and 10 years were 53.2 ± 8.6% and 49.1 ± 8.9%, respectively. Among the survivors, only 6 (26.1%) patients died during follow-up with a 5-year and 10-year overall survival rate of 80.9 ± 8.7% and 74.7 ± 10%, respectively. CONCLUSIONS: These data suggest a trend towards long-term benefit in patients surviving high-risk surgery for LVFWR repair. Considering the high lethality of LVFWR, the urgency and complexity of the primary surgical intervention early diagnosis and prompt surgery play a key role in the management of this complication.

AB - OBJECTIVES: Left ventricular free wall rupture (LVFWR) is a catastrophic complication following acute myocardial infarction with an estimated incidence of 0.2-7.6% and mortality can be as high as 60%. This study aimed to identify the risk factors for morbidity and mortality in patients affected by LVFWR. METHODS: This is a retrospective study of 35 patients who underwent surgery for LVFWR between January 2000 and December 2016 at our institution. RESULTS: The mean age of patients was 68.3 years. The in-hospital survival was 65.7% (n = 23), and 13% of survived patients presented with cardiac arrest. The following characteristics were associated with in-hospital mortality at univariable analysis: pre-existing hypertension (P = 0.02), need for inotropes (P = 0.02) and cardiac arrest (P < 0.0001) at presentation, cardiopulmonary resuscitation (P = 0.004), preoperative extracorporeal membrane oxygenation (P = 0.004), technique of LVFWR repair (P = 0.013), operation on extracorporeal membrane oxygenation (P = 0.005) and postoperative extracorporeal membrane oxygenation (P = 0.001). In the multivariable analysis, cardiac arrest at presentation was an independent predictor of in-hospital mortality (odds ratio 11.7, 95% confidence interval 2.352-59.063; P = 0.003). The overall mean postoperative follow-up was 8.3 ± 1.3 years. Overall survival rates at 5 and 10 years were 53.2 ± 8.6% and 49.1 ± 8.9%, respectively. Among the survivors, only 6 (26.1%) patients died during follow-up with a 5-year and 10-year overall survival rate of 80.9 ± 8.7% and 74.7 ± 10%, respectively. CONCLUSIONS: These data suggest a trend towards long-term benefit in patients surviving high-risk surgery for LVFWR repair. Considering the high lethality of LVFWR, the urgency and complexity of the primary surgical intervention early diagnosis and prompt surgery play a key role in the management of this complication.

KW - Acute myocardial infarction

KW - Cardiogenic shock

KW - Extracorporeal membrane oxygenation

KW - In hospital survival

KW - Ventricular wall

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