Surgical Treatment of Post-Infarction Left Ventricular Free-Wall Rupture: A Multicenter Study

Meta‐analysis of surgical treatment for postinfarction left ventricular free‐wall rupture

“…The study selection process and reasons for exclusion are described in Figure S1 . After removal of articles not pertinent to the design of the current study, 11 reports 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 with suitable data were included in the final meta‐analysis. All selected papers were published after 2001.…”

“…This study found a clear negative effect of the postoperative VA-ECMO insertion with an increasing of 2.4-fold the odds of operative mortality.However, given the retrospective nature of the study, one can hypothesize that most of patients requiring postoperative VA-ECMO are part of the worst subgroup in terms of extension of myocardial infarction, myocardial tissue damage and irreversible brain damage and in such clinical scenario VA-ECMO institution maybe sometimes considered as compassionate use. Although the indications for VA-ECMO support are widely recognized, as well as the weaning and management strategies, in this meta-analysis it was not possible to identify the appropriate indications for the use of VA-ECMO in the postoperative period for two main reasons: first, few patients (26/363, 11%) received postoperative VA-ECMO support and of these it was not possible to identify exactly the causes determining the need for the mechanical support besides the CPB weaning failure; second, none of the four studies(10,11,13,14) that reported the postoperative VA-ECMO implant have focused on the indications and management strategies such as weaning due to myocardial recovery, bridging to the heart transplant or to long-term left ventricular assist device. Further studies are needed to address this issue thoroughly.…”

Surgical repair of post-infarction ventricular free-wall rupture in the Netherlands: data from a nationwide registry

“…Major comorbidities and known cardiovascular risk factors, such as diabetes mellitus, peripheral vascular disease and previous cerebrovascular accidents were identified in a minority of patients and were not associated with higher inhospital mortality. In the CAUTION LVFWR study (3), which represents the largest report to date of patients undergoing cardiac surgery for post-AMI VFWR, the majority of subjects (70%) were in cardiogenic shock at presentation, and cardiac arrest was identified as an independent risk factor for operative mortality. Similarly, in our cohort most patients presented in a critical status before surgery, and this condition was found to significantly increase the risk of death.…”

“…The development of a post-acute myocardial infarction (AMI) ventricular free-wall rupture (VFWR) is an uncommon but highly fatal complication, occurring in less than 1% of patients sustaining AMI in the modern era of early reperfusion therapy (1). In post-AMI VFWR patients treated medically, mortality rate accounts for approximately 90% (2), whereas mortality in patients undergoing surgical repair ranges between 17% and 36% (3)(4)(5). Given the rare nature of this entity, most previous studies on surgical outcomes have been confined to single-center retrospective analyses with a relatively small sample size.…”

Left ventricular free wall rupture: A real nightmare

“…The authors are to be congratulated on this, as they should also be on a similar study in patients with interventricular septal rupture (VSR) after AMI, another complex postinfarction complication, very recently published in another Journal. 6 And the current paper is a complement of a paper on the same subject (LVFWR), also recently published, 7 on 140 patients from the CAUTION study database who were surgically treated for post-AMI LVFWR in 15 different centers from 2001 to 2018, from which they concluded that "surgical repair of postinfarction LVFWR carries a high operative mortality. Female gender, preoperative left ventricular ejection fraction, cardiac arrest, and extracorporeal life support, are predictors of early mortality," which differs little from the conclusions derived from the meta-analysis now made.…”