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

7 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

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

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    Formica, F., Mariani, S., Singh, G., D'Alessandro, S., AmerigoMessina, L., Jones, N., Bamodu, O. A., Sangalli, F., & 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