title: Efficacy of TachoSil® as a sutureless hemostatic patch to repair a perforation of the interventricular groove during endocardial radiofrequency ablation.
abstract: Catheter ablation is a well-established therapeutic option for management of recurrent ventricular tachycardia in patients with ischemic/non-ischemic heart disease and procedural complications include a mortality rate of up to 3% and a risk of major complications up to 10%. Cardiac perforation following a catheter ablation is rare but serious complication and occurs in 1% of ventricular ablation procedures. The appropriate surgical repair may be challenging and need cardiopulmonary bypass support according to the location of the lesion and the hemodynamic status of the patient. We report the case of a free wall right ventricular perforation of the interventricular groove with cardiac tamponade following catheter ablation for recurrent ventricular tachycardia. Due to the proximity of the left anterior descending artery and the extreme fragility of tissues, the patient was treated successfully by a sutureless patch technique using a fibrin tissue-adhesive collagen fleece (TachoSil®). This technique is a safe and effective surgical option to repair a ventricular perforation especially when the ventricular tissues are fragile. It is simple and enable to realize surgical repair also if the localization of tear is difficult to access and without the need for cardiopulmonary bypass support if hemodynamic conditions are stable.
authors.affiliation: Department of Cardiovascular Surgery and Heart Transplantations, ILCV Louis-Mathieu CHU Nancy, Vandoeuvre-lès-Nancy, France - fioreant7@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Fiore
authors.forename: D
authors.initials: D
authors.lastname: Grandmougin
authors.forename: J P
authors.initials: JP
authors.lastname: Maureira
authors.forename: M
authors.initials: M
authors.lastname: Elfarra
authors.forename: N
authors.initials: N
authors.lastname: Laurent
authors.forename: M
authors.initials: M
authors.lastname: Andronache
authors.forename: T
authors.initials: T
authors.lastname: Folliguet
authors.forename: J P
authors.initials: JP
authors.lastname: Villemot
mesh_terms: D000369:Aged, 80 and over; D002305:Cardiac Tamponade / Q000209:etiology / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects*; D004338:Drug Combinations; D004699:Endocardium / Q000601:surgery*; D005340:Fibrinogen / Q000627:therapeutic use*; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D008297:Male; D010490:Pericardial Effusion / Q000209:etiology / Q000601:surgery; D013917:Thrombin / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D004338:Drug Combinations; C518955:TachoSil; D005340:Fibrinogen; D013917:Thrombin