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Review
. 2021 Sep;36(9):3326-3333.
doi: 10.1111/jocs.15701. Epub 2021 Jun 1.

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

Matteo Matteucci  1   2 , Francesco Formica  3 , Mariusz Kowalewski  1   4   5 , Giulio Massimi  1   6 , Daniele Ronco  1   2 , Cesare Beghi  2 , Roberto Lorusso  1
Affiliations
Review

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

Matteo Matteucci et al. J Card Surg. 2021 Sep.

Abstract

Background: Left ventricular free-wall rupture (LVFWR) is one of the most lethal complications after acute myocardial infarction (AMI). The optimal therapeutic strategy is controversial. The current meta-analysis sought to examine the outcome of patients surgically treated for post-AMI LVFWR.

Methods: A comprehensive literature review was performed to identify articles reporting outcomes of subjects who underwent LVFWR surgical repair. The primary endpoint was operative mortality. A meta-analysis was performed to assess the associations of predefined variables of interest and clinical prognosis.

Results: Of the 3132 retrieved articles, 11 nonrandomized studies, enrolling a total of 363 patients, fulfilled the inclusion criteria and were included in this analysis. The mean age of patients was 68 years. The operative mortality rate was 32% (n = 115). Meta-analysis revealed reduced operative risk in patients with oozing type rupture, as compared to blowout type (risk ratios [RR]: 0.47; 95% confidence interval [CI]: 0.33-0.67; p < .0001); RR was also significantly reduced in subjects in whom LVFWR was treated with sutureless technique, as compared to those undergoing sutured repair (RR: 0.59; 95% CI: 0.41-0.83; p = .002). Increased risk of operative mortality was demonstrated in patients who required postoperative extracorporeal membrane oxygenation (ECMO) support (RR: 2.39; 95% CI: 1.59-3.60; p < .0001).

Conclusions: Surgical treatment of postinfarction LVFWR has a high operative mortality rate. Blowout rupture, sutured repair and postoperative ECMO support are factors associated with increased risk of operative mortality.

Keywords: acute myocardial infarction; surgical repair; ventricular rupture.

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Conflict of interest statement

Roberto Lorusso consultant for Medtronic and LivaNova, and member of the Advisory Board of Eurosets and PulseCath. Other authors have no conflict of interests.

Figures

Figure 1
Figure 1
Forrest plots of comparison (from above to below): (A) oozing rupture versus blowout rupture; (B) sutureless repair versus sutured repair; (C) preoperative IABP support versus no IABP support; outcome of interest: operative mortality. IABP, intraaortic balloon pump
Figure 2
Figure 2
Forrest plots of comparison (from above to below): (A) antero‐apical rupture versus postero‐lateral rupture; (B) concomitant CABG versus no CABG; (C) postoperative ECMO support versus no ECMO support; outcome of interest: operative mortality. CABG, coronary artery bypass grafting; ECMO, extracorporeal membrane oxygenation
Figure 3
Figure 3
Forrest plots of comparison (from above to below): (A) on‐pump repair versus off‐pump repair; postoperative IABP support versus no IABP support; outcome of interest: operative mortality. IABP, intraaortic balloon pump
See this image and copyright information in PMC

References

    1. Elbadawi A, Elgendy IY, Mahmoud K, et al. Temporal trends and outcomes of mechanical complications in patients with acute myocardial infarction. JACC Cardiovasc Interv. 2019;12(18):1825‐1836. - PubMed
    1. French JK, Hellkamp AS, Armstrong PW, et al. Mechanical complications after percutaneous coronary intervention in ST‐elevation myocardial infarction (from APEX‐AMI). Am J Cardiol. 2010;105(1):59‐63. - PubMed
    1. Figueras J, Cortadellas J, Soler‐Soler J.Left ventricular free wall rupture: clinical presentation and management. Heart. 2000;83(5):499‐504. - PMC - PubMed
    1. Figueras J, Alcalde O, Barrabés JA, et al. Changes in hospital mortality rates in 425 patients with acute ST‐elevation myocardial infarction and cardiac rupture over a 30‐year period. Circulation. 2008;118(25):2783‐2789. - PubMed
    1. López‐Sendón J, Gurfinkel EP, Lopez de Sa E, et al. Global Registry of Acute Coronary Events (GRACE) Investigators. Factors related to heart rupture in acute coronary syndromes in the Global Registry of Acute Coronary Events. Eur Heart J. 2010;31(12):1449‐1456. - PubMed