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Meta-analysis of surgical treatment for postinfarction left ventricular free-wall rupture.
Matteucci, Matteo; Formica, Francesco; Kowalewski, Mariusz; Massimi, Giulio; Ronco, Daniele; Beghi, Cesare; Lorusso, Roberto.
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  • Matteucci M; Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.
  • Formica F; Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy.
  • Kowalewski M; Unit of Cardiac Surgery, Department of Medicine and Surgery, University of Parma, University Hospital of Parma, Parma, Italy.
  • Massimi G; Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.
  • Ronco D; Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland.
  • Beghi C; Department of Cardiac Surgery, Niguarda Hospital, Milan, Italy.
  • Lorusso R; Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.
J Card Surg ; 36(9): 3326-3333, 2021 Sep.
Article en En | MEDLINE | ID: mdl-34075615
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Rotura Cardíaca Posinfarto / Oxigenación por Membrana Extracorpórea / Rotura Cardíaca / Infarto del Miocardio Tipo de estudio: Etiology_studies / Prognostic_studies / Systematic_reviews Límite: Aged / Humans Idioma: En Revista: J Card Surg Asunto de la revista: CARDIOLOGIA Año: 2021 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Rotura Cardíaca Posinfarto / Oxigenación por Membrana Extracorpórea / Rotura Cardíaca / Infarto del Miocardio Tipo de estudio: Etiology_studies / Prognostic_studies / Systematic_reviews Límite: Aged / Humans Idioma: En Revista: J Card Surg Asunto de la revista: CARDIOLOGIA Año: 2021 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Estados Unidos