Background: Acute myocardial infarction can result in ischemic, mechanical, arrhythmic, embolic or inflammatory complications. Despite high operative mortality, the lack of an effective and immediate medical alternative makes the surgery repair the mainstay of current management for these patients. Novel surgical approaches are presented to manage these complications.
Main body: Mechanical complications presented at the Department of Cardiac Surgery-Tirana University Medical Centre consisted in nine cases during the period January 2008-June 2018: two anterolateral papillary muscle rupture cases (22%), one posteromedial papillary muscle rupture case (11%), two ventricular septal rupture cases (22%), one free ventricle wall rupture case (11%), three chordae tendineae rupture cases (33%), four out of nine patients (44,5%) underwent concomitant CABG intervention. Intra operator mortality is estimated 11% (one out of nine cases). The Department of Cardiac Surgery-Tirana University Medical Centre is limited only in open surgery techniques for repair the post myocardial infarction mechanical complications. To our personal view key reasons for these results are conditioned from lack of medical devices, trained stuff, reliable short and long outcome data from alternative procedures in order to incorporate thus in our daily practice. Further studies should be undertaken not only to create a precise image of the situation, but also to evaluate the results of the possible changes.
Key words: Acute myocardial infarction, mechanical complications, papillary muscle rupture, ventricular septal rupture, free ventricle wall rupture, CABG intervention.
Ramesh S.Kutty, Nicola Jones, Narain Moorjani, 2013. Mechanical Complications of Acute Myocardial Infarction. Cardiology Clinics, 31(4), pp. 519-531.
Reeder, G. S., 1995. Identification and Treatment of Complications of Myocardial Infarction. Mayo Clinic Proceedings, 70(9), pp. 880-884.
Kasim Oguz Coskun, Sinan Tolga Coskun, Aron Frederik Popov, Jose Hinz, Jan Dieter Schmitto, Kerstin Bockhorst, Kathrin Monika, Reiner Koerfer, 2009. Experiences with surgical treatment of ventricle septal defect as a post infarction complication. Journal of Cardiothoracic Surgery, 4(3).
Němec P, Ondrášek J, Fila P, Bedáňová H, Pavlík P., 2014. Surgical therapy of myocardial infarction. Vnitr Lek, 60(4), pp. 331-334.
Rick A. Nishimura, Hartzell V. Schaff, Bernard J. Gersh,, 1986. Early Repair of Mechanical Complications After Acute Myocardial Infarction. JAMA Network, Volume 256, pp. 47-50.
Pedro Magalhães, Pedro Mateus, Sofia Carvalho, Sílvia Leão, Filipa Cordeiro, J Ilídio Moreira,, 2016. Relationship between treatment delay and type of reperfusion therapy and mechanical complications of acute myocardial infarction. Europian Heart Journal, 5(5), pp. 468-474.
B. Redfors, O. Angeråsa, T. Råmunddala, C. Dworecka, I. Haraldssona, D. Ioanesa, P. Peturssona, B. Libungana, J. Odenstedta, J. Stewartb, E. Lodinc, M. Wahlin, 2015. 17-year trends in incidence and prognosis of cardiogenic shock in patients with acute myocardial infarction in western Sweden. International Journal of Cardiology, Volume 185, p. 256–262.
Farshad Shakerian, Hamid-Reza Sanati,Hosein Hoseinzadeh,Ata Firouzi, Ali Zahedmehr, Reza Kiani, Mahdieh Doaee, Akbar Nikpajouh, 2017. Early and Midterm Prognoses of Mechanical Complications Following. Iranian Heart Journal, 18(4).
Shih-Ming Huang, Shu-Chien Huang, Chih-Hsien Wang, I-Hui Wu, Nai-Hsin Chi, Hsi-Yu Yu, Ron-Bin Hsu, Chung-I Chang, Shoei-Shen Wang and Yih-Sharng ChenEmail author, 2015. Risk factors and outcome analysis after surgical management of ventricular septal rupture complicating acute myocardial infarction: a retrospective analysis. Journal of Cardiothoracic Surgery, 10(66).
Geka, K., 1998. The investigation of surgical procedures for post infarcted ventricular septal defects: a comparison between Daggett and David method. The Japanese Journal of Thoracic Surgery , 51(13), pp. 1110-1113.
Runar Lundblad, Michel Abdelnoor, 2014. Surgery of postinfarction ventricular septal rupture: The effect of David infarct exclusion versus Daggett direct septal closure on early and late outcomes. The Journal of Thoracic and Cardiovascular Surgery, 148(6), pp. 2736-2742.
Bobby Yanagawa, Vivek Rao, Terrence M. Yau, Robert Cusimano, 2013. Initial Experience with Intraventricular Repair Using CorMatrix Extracellular Matrix. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 8(5).
Xian-Yang Zhu, Yong-Wen Qin, Ya-Ling Han, Duan-Zhen Zhang, Ping Wang, Ying-Feng Liu,Ya-Wei Xu, Quan-Min Jing, Kai Xu, Bernard J. Gersh, Xiao-Zeng Wang, 2013. Long-term efficacy of transcatheter closure of ventricular. EuroIntervention, Volume 8, pp. 1270-1276.
Gabriele Egidy Assenza , Doff B. McElhinney , Anne Marie Valente , Disty D. Pearson , Massimo Volpe , Giuseppe Martucci , Michael J. Landzberg , James E. Lock, 2013. Transcatheter Closure of Post-myocardial Infarction Ventricular Septal Rupture. Circulation: Cardiovascular Intervention, 6(1), p. 59–67.
Brandon M. Jones , Samir R. Kapadia, Nicholas G. Smedira , Michael Robich, E. Murat Tuzcu , Venu Menon , Amar Krishnaswamy, 2014. Ventricular septal rupture complicating acute myocardial infarction: a contemporary review. European Heart Journal, 35(31), p. 2060–2068.
Ted Feldman ,Amelia Young, 2014. Percutaneous Approaches to Valve Repair for Mitral Regurgitation. Journal of the American College of Cardiology, 63(20), pp. 2057-2068.
Miriam Puls, Edith Lubos, Peter Boekstegers ,Ralph Stephan von Bardeleben ,Toufik Ouarrak ,Christian Butter ,Christine S. Zuern ,Raffi Bekeredjian, Horst Sievert ,Georg Nickenig , Holger Eggebrecht ,Jochen Senges , Wolfgang Schillinger, 2016. One-year outcomes and predictors of mortality after MitraClip therapy in contemporary clinical practice: results from the German transcatheter mitral valve interventions registry. European Heart Journal, 37(8), pp. 703-712.
Kentaro Hayashida, Satoshi Yasuda, Takashi Matsumoto, Makoto Amaki, Shingo Mizuno, Tetsuya Tobaru, Kentaro Jujo, Tatsushi Ootomo, Junichi Yamaguchi, Keiichi Fukuda, Shigeru Saito, Elyse Foster, Atif Qasim, Masafumi Kitakaze, Ryohei Yozu, Morimasa Takayama, 2017 . Baseline Characteristics and 30-Day Outcomes Following MitraClip Treatment in a Japanese Cohort. Circulation Journal, 81(8), pp. 1116-1122.
Sokol Myftiu, Petrit Bara, Ilir Sharka,Artan Shkoza, Xhina Belshi, Edlira Rruci, Gentian Vyshka, 2016 . Heart Failure Predictors in a Group of Patients with Myocardial Infarction. Open Access Macedonian Journal of Medical Sciences, 4(3), p. 435–438.
Sokol Myftiu, Petrit Bara, Ilir Sharka, Artan Shkoza, Xhina Belshi, Edlira Rruci, Gentian Vyshka, 2016 . Heart Failure Predictors in a Group of Patients with Myocardial Infarction. Macedonian Journal of Medical Sciences, 15(3), p. 435–438.
Center, M. U. M., 2019. ClinicalTrials.gov. [Online] Available at: https://clinicaltrials.gov/ct2/show/NCT03848429
Elena Puerto, Ana Viana-Tejedor ,Manuel Martínez-Sellés, Laura Domínguez-Pér, Guillermo Moreno, Roberto Martín, Héctor Bueno, 2018. Temporal Trends in Mechanical Complications of Acute Myocardial Infarction in the Elderly. Journal of the American College of Cardiology, 72(9), pp. 959-966.
Jonas Lanz, Dörte Wyss, Lorenz Räber, Stefan Stortecky, Lukas Hunziker, Stefan Blöchlinger, David Reineke, Lars Englberger, Thomas Zanchin, Marco Valgimigli, Dik Heg, Stephan Windecker, Thomas Pilgrim, 2019. Mechanical complications in patients with ST-segment elevation myocardial infarction: A single centre experience. Plos One, 14(2).
Seong Ho Cho, Wook Sung Kim, 2016. Transatrial Approach for the Repair of the Posterior Post-Infarct Ventricular Septal Rupture. Korean Circulation Journal, 46(1), pp. 107-110.
Sung Kwang Lee ,Woon Heo, Ho-Ki Min, Do Kyun Kang, Hee Jae Jun, Youn-Ho Hwang, 2015. A New Surgical Repair Technique for Ischemic Total Papillary Muscle Rupture. The Annals of Thoracic Surgery, 100(5), pp. 1891-1893.
Marianna Adamoa, Salvatore Curelloa, Ermanna Chiarib, Claudia Fiorinaa, Giuliano Chizzolaa, Marco Magatellia, Elisa Locantorea, Giovanni Cuminettia, Carlo Lombardib, Aldo Manzatoc, Marco Metrab, Federica Ettoria, 2017. Percutaneous edge-to-edge mitral valve repair for the treatment of acute mitral regurgitation complicating myocardial infarction: A single centre experience. International Journal of Cardiology , Volume 234, p. 53–57.
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