Mohamed S, Mazhar K, Patel A J, Jeeji R, Ridley P, Balacumaraswami L
Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke-On-Trent, UK.
Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
J Surg Case Rep. 2021 Mar 15;2021(3):rjab073. doi: 10.1093/jscr/rjab073. eCollection 2021 Mar.
We describe an off-pump surgical approach to this challenging condition supported by our results from a case series, which would add to existing literature in the management of this life-threatening complication. We identified seven patients who underwent surgical intervention for left ventricular (LV) free wall rupture at our institution. They were all diagnosed to have cardiac tamponade secondary to free wall rupture of the LV in the presence of acute myocardial infarction. The surgical technique comprised of utilizing an external pericardial patch which was secured using surgical biological glues (fibrin-based sealants or gelatin hydrogels). The 30-day mortality, 1-year survival and 2-year survival were 57, 42 and 42%, respectively. Advanced age, female gender and use of cardiopulmonary bypass were characteristics that were not significantly associated with survival. We advocate the use of an off-pump external pericardial patch repair strategy as a 'bridge to recovery' in this extremely high-risk group of patients.
我们通过一个病例系列的结果，描述了一种用于这种具有挑战性情况的非体外循环手术方法，这将为这种危及生命并发症的管理方面的现有文献增添内容。我们确定了7例在我们机构接受左心室游离壁破裂手术干预的患者。他们均被诊断为在急性心肌梗死情况下继发于左心室游离壁破裂的心脏压塞。手术技术包括使用外部心包补片，并用外科生物胶水（纤维蛋白基密封剂或明胶水凝胶）固定。30天死亡率、1年生存率和2年生存率分别为57%、42%和42%。高龄、女性性别和使用体外循环不是与生存显著相关的特征。我们主张在这一极高风险患者群体中，使用非体外循环外部心包补片修复策略作为“恢复桥梁”。
