Patch-and-glue repair in combination with or without direct suture for cardiac rupture after myocardial infarction

• Published in: General thoracic and cardiovascular surgery 2007-09, Vol.55 (9), p.345-350
• Main Authors: Fujimatsu, Toshihiro, Oosawa, Hajime, Takai, Fumie, Aruga, Masakazu, Ogiwara, Fumiaki, Mawatari, Eiichiro, Sakurai, Shunpei
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cardiac Surgical Procedures; Female; Heart attacks; Heart Rupture, Post-Infarction - surgery; Humans; Male; Middle Aged; Suture Techniques
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-007-0144-4

Left ventricular free-wall rupture is a catastrophic event after myocardial infarction. The most appropriate surgical management remains controversial. We have performed a patch-and-glue technique, with or without direct suture and using cardioplegic arrest, to treat postinfarction cardiac rupture. We describe our experiences over a 5-year period, and discuss the optimal surgical repair for each type of rupture. Since 2002, we have managed 5 patients with cardiac rupture. Two patients had a blowout rupture, 2 were of the subacute type, and 1 experienced an oozing rupture. There were 3 men and 2 women, with an average age of 76.2 +/- 12.5 years. Echocardiography confirmed the diagnosis in all patients. Two patients underwent a patch-and-glue repair in combination with direct suture, one had an infarctectomy, and the others had a completely sutureless patch-and-glue treatment performed using cardioplegic arrest. All patients survived the initial treatment and were moved to the intensive care unit with complete hemostasis. The 2 patients who were treated in combination with direct suture died of brain death or cardiac failure (mortality rate 40%). The 3 patients who were treated with the patch-and-glue sutureless technique were discharged from our hospital, and are alive 15-27 months after the operation. Two are doing well, and the other is breathing on his own but remains nonreactive. We prefer the patch-and-glue sutureless technique even for a blowout rupture. We performed cardioplegic arrest to provide a bloodless surgical field and maximize adhesive function. The whole necrotic area should be covered with a large patch of appropriate size.