Department of Medicine and Surgery, Cardiac Surgery Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
Division of Cardiac Surgery, Department of Critical Care Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada.
Eur J Cardiothorac Surg. 2018 Jan 1;53(1):150-156. doi: 10.1093/ejcts/ezx271.
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.
This is a retrospective study of 35 patients who underwent surgery for LVFWR between January 2000 and December 2016 at our institution.
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.
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.
左心室游离壁破裂（LVFWR）是急性心肌梗死后的灾难性并发症，估计发病率为 0.2-7.6%，死亡率高达 60%。本研究旨在确定影响 LVFWR 患者发病率和死亡率的危险因素。
这是一项回顾性研究，纳入了 2000 年 1 月至 2016 年 12 月期间在我院接受 LVFWR 手术的 35 名患者。
患者的平均年龄为 68.3 岁。院内存活率为 65.7%（n=23），存活患者中有 13%出现心脏骤停。单变量分析显示，以下特征与院内死亡率相关：存在高血压（P=0.02）、入院时需要使用正性肌力药（P=0.02）和心脏骤停（P<0.0001）、心肺复苏（P=0.004）、术前体外膜肺氧合（P=0.004）、LVFWR 修复技术（P=0.013）、在体外膜肺氧合上进行手术（P=0.005）和术后体外膜肺氧合（P=0.001）。多变量分析显示，入院时发生心脏骤停是院内死亡的独立预测因素（比值比 11.7，95%置信区间 2.352-59.063；P=0.003）。总体平均术后随访时间为 8.3±1.3 年。5 年和 10 年总生存率分别为 53.2±8.6%和 49.1±8.9%。在幸存者中，只有 6 名（26.1%）患者在随访期间死亡，5 年和 10 年总生存率分别为 80.9±8.7%和 74.7±10%。
这些数据表明，对于高危 LVFWR 修复手术的存活患者，长期受益呈上升趋势。鉴于 LVFWR 的高致死率，早期诊断和及时手术在管理这种并发症中起着关键作用。
