Employing Amplatzer Occluder® in Cardiac Free Wall Rupture Repair: A Scoping Study

Abstract

Cardiac free wall rupture (CFWR) is an uncommon complication of myocardial infarction, cardiac-based procedures, and blunt chest trauma. Cardiac tamponade and shock which occurs as a result of CFWR results in a high mortality rate. Despite the high mortality rate, there is a window of opportunity for intervention in selected patients with acute or subacute free wall rupture. Hence, prompt diagnosis and intervention are key to prevent cardiac tamponade and death. Even though emergency surgical repair is the standard treatment for the CWFR, the catheter-based procedure has provided an alternative treatment option, especially, in the high-risk surgical patients. For instance, Amplatzer occluder® (AO), a device which is used in repairing congenital septal swall defect, is being used as an alternative method of treatment in CFWR. In this systemic review, we assessed the 19 cases of CFWR occurring after invasive cardiac procedures who underwent repair with the utilization of AO®. The study shows that the successful rate of percutaneous closure of CFWR was 84.3% (16/19) with a mortality rate of 15.7% (3/19) in this cohort. Therefore, the in-hospital mortality rate of CFWR closure is comparable with the average in-house mortality rate of emergency surgical repair which is 14%. Furthermore, we found that AO® placement technique has a lower mortality rate compared to the other less-invasive methods such as percutaneous intrapericardial fibrin-glue injection which has a mortality rate of 25%. In conclusion, employing AO® in CFWR repair not only serves as the treatment of choice in the high-risk surgical candidates but could also be applied as an alternative method in the general population. However, further studies are required to assess the outcome and mortality rate of using A® in CFWR to provide us with a more consistent and accurate data.