Management of Stab Wounds of the Heart: Analysis of 73 Cases in 10 Years

Abstract

Stab wounds of the heart still cause a significant number of traumatic deaths every year. The aim of this study was to assess the outcome of patients with cardiac stab wounds requiring emergency thoracotomy. Preoperative and operative variables were reviewed for all patients treated at the Mansoura Emergency Hospital between August 1998 and July 2008. Seventy-three patients were treated for stab wounds of the heart. Of these 69 were male (94.5 %) and only 4 were female (5.5 %). Mean patient age was 28.5 +/- 5.8 years. The clinical status was stable in 22 patients (30.1 %) and unstable in 26 patients (35.6 %), while 10 patients were in shock (13.7 %), and 15 patients had suffered cardiac arrest prior to thoracotomy (20.6 %). Emergency room (ER) thoracotomy was performed in 18 patients (24.7 %) and operative room (OR) thoracotomy was carried out in 55 patients (75.3 %). The commonest location of stab wounds to the heart was the right ventricle in 28 patients (38.4 %) followed by the left ventricle in 25 patients (34.2 %). Mortality was 23.3 % (17 patients), and morbidity was 21.4 % (12 patients out of 56 surviving patients). Prognostic factors included clinical status (patients in shock or cardiac arrest had a mortality rate of 50 % and 60 %, respectively), cardiopulmonary resuscitation (CPR; mortality rate: 68.2 %) and ER thoracotomy (mortality rate: 66.7 %). Clinical status as shock, CPR and ER thoracotomy were prognostic of a poor outcome and associated with high mortality rates.