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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Fujimatsu
Toshihiro
T
Department of Cardiovascular Surgery, Heart Center, Aizawa Hospital, 2-5-1 Honjou, Matsumoto, Nagano 390-8510, Japan. sin-dr@ai-hosp.or.jp
Oosawa
Hajime
H
Takai
Fumie
F
Aruga
Masakazu
M
Ogiwara
Fumiaki
F
Mawatari
Eiichiro
E
Sakurai
Shunpei
S
D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013536:Suture Techniques