[Surgical management of cardiac wounds: cardiac or general surgical service?].
OBJECTIVE
To define modalities of cardiac wound management with a special emphasis on the initial direction of the patient toward a surgical service, rapid diagnosis, and surgical treatment.


METHODS
Sixteen patients with thoracic injury to the region of the heart treated between 1996 and 2006 were evaluated retrospectively. Pre-operative clinical data, echography, and CT results were collected; time elapsed between injury and treatment, type of surgical treatment, use of cardio-pulmonary bypass, morbidity and mortality were evaluated.


RESULTS
There were 16 patients (12 men); age ranged from 18 to 80 with an average of 45.7 years. Nine patients had penetrating cardiac wounds, two had blunt trauma, and five suffered iatrogenic trauma. Cardio-pulmonary bypass was used in two cases. The mean time elapsed between trauma and surgical evaluation was 63 minutes (p=0.18). In all cases, surgery consisted of a myorraphy without coronary or valvular repair. Post-operative complications occurred in 4 patients (25%) and resulted in 2 deaths (12.5%). Complication and death were associated with a prolonged interval between injury and surgical management.


CONCLUSIONS
Patients with cardiac wounds should be transported to the nearest surgical hospital. There are no benefits to cardio-pulmonary bypass in cardiac trauma.
Avaro
J-P
JP
Service de chirurgie thoracique, hôpital d'instruction des armées Laveran, Marseille. Jpavaro@wanadoo.fr
Grisoli
D
D
Gariboldi
V
V
Piccardo
A
A
Riberi
A
A
Kerbaul
F
F
Metras
D
D
Collart
F
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016507:Cardiology Service, Hospital; D002315:Cardiopulmonary Bypass; D005260:Female; D006335:Heart Injuries / Q000175:diagnosis / Q000601:surgery*; D006769:Hospitals, General; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013503:Surgery Department, Hospital; D016019:Survival Analysis; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000601:surgery*; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000601:surgery*