EComment. The patch and glue technique with or without TachoSil(R)?

Abstract

I read with great interest the paper by Pocar and colleagues regarding the use of TachoSil® (Nycomed, Zurich, Switzerland) as a modification of the classic patch and glue sutureless repair for left ventricular free wall rupture secondary to myocardial infarction [1]. They successfully treated three patients with postinfarction free wall rupture using cardiopulmonary bypass without cardiac arrest. Instead of applying the glue directly on the infarction area and then covering it with a biological or synthetic patch, they initially applied several layers of a fibrinogen/thrombin-coated collagen patch on the oozing surface of the heart [1].The authors stated that no false aneurysm was observed during the follow-up period, however the duration of the follow-up in this paper is unclear. In 1988, Padro and colleagues [2] reported the first case of postinfarction cardiac rupture successfully treated with a sutureless technique using a Teflon patch and biocompatible glue. Since then, many alternatives have been described in the literature to cover myocardial perforations, involving Teflon, Dacron, Goretex or pericardial patches and different biological glues [3]. Encouraging results of the sutureless technique without the use of TachoSil® have led some authors to advocate the patch and glue repair over the classic infarcectomy repair [4].The patch and glue technique is considered simple, safe and effective, but the number of patients treated is limited with different techniques. Another major drawback of this technique is the absence of long-term imaging follow-up results. Recently, Zoffoli and colleagues [5] reported no early or late myocardial ruptures (mean follow-up of 6.7 years) at the treatment site in 25 consecutive patients with postinfarction cardiac rupture. Others have published less favourable results with 37% (3 out of 8 patients) developing aneurysms at the site of the repair [3]. Long-term follow-up is important to determine whether this technique is promising and durable. Close imaging follow-up is paramount in this patient population.