title: Is it ever possible to treat left ventricular free wall rupture conservatively?
abstract: A best evidence topic was written according to a structured protocol. The question addressed was whether conservative or surgical management would result in better outcomes in patients presenting with left ventricular free wall rupture (LVFWR) following acute myocardial infarction. Surgical techniques involved were infarctectomy + patch repair, suturing of an overlay patch to the defect, patch-and-glue repair and so on, on or off cardiopulmonary bypass. A total of 210 papers were found using the reported searches, of which 10 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results were tabulated. The studies found analysed the outcome related to conservative and surgical approaches plus the effects of cardiopulmonary bypass circuit and systemic heparinization on bleeding around the peri-infarct myocardial tissue in the surgical group. Most of the data available were either case reports or retrospective analysis of the cohort using the 2 techniques and showed that ruptures present in different sites and sizes. Patients with a milder form of LVFWR can be managed conservatively, but the irony is that it is difficult to identify these patients, because a small oozing-type rupture can increase in size and lead to large defect with sudden arrest of the patient and most probably death. More recently with patch-and-glue techniques, avoiding cardiopulmonary bypass, short- and mid-term survival rates have improved to 60-80% in studies of consecutive patients' series, which illustrates real-life experiences.
authors: Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK dranasir@gmail.com.
authors: Abdul
authors: A
authors: Nasir
authors: Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK.
authors: Mohammad
authors: M
authors: Gouda
authors: Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK.
authors: Amir
authors: A
authors: Khan
authors: Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK.
authors: Amal
authors: A
authors: Bose
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002315:Cardiopulmonary Bypass; D019317:Evidence-Based Medicine; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute myocardial infarction; Conservative treatment; Left ventricular free wall rupture; Surgical repair