Abstract
A 70-year-old woman was admitted to our institution with acute myocardial infarction. Coronary angiography demonstrated total occlusion of the left anterior descending artery, which was successfully revascularized. Four days later, the patient suddenly went into shock. The subsequent emergency operation revealed a blowout rupture of the left ventricular free wall. Several TachoComb® (CSL Behring, Tokyo, Japan) sheets were applied to control bleeding and avoid the need for a cardiopulmonary bypass. Horizontal mattress sutures were used in combination with a pair of Teflon felt strips for reinforcement. The combination of TachoComb® sheets and sutures is a novel hybrid method and an effective life-saving procedure for the treatment of left ventricular blowout ruptures. This approach avoids the need for a cardiopulmonary bypass. Sutureless repairs with TachoComb® sheet achieve rapid hemostasis without the need for cardiopulmonary bypass. This stabilizes patient hemodynamics immediately and preserves the fragile myocardium. This allows emergency room physicians to open the chest and apply the TachoComb® sheet to stabilize the patient before the cardiac surgeons arrive at the operating room. This technique will be very useful in emergency situations.
Highlights
Left ventricular (LV) free wall rupture is a serious complication of acute myocardial infarction that may result in acute cardiac tamponade and sudden death
Unlike prepare-to-use fibrin sealants, which require the coating of fibrin glue onto fleece or patching immediately before or during surgery, TachoComb® is a ready-to-use fixed combination that is activated by moisture upon application, providing adherence to the resection surface
The choice among them is made on the basis of three main considerations: (1) type of rupture, (2) with or without cardiopulmonary bypass (CPB), and (3) suture closure or sutureless repair
Summary
Left ventricular (LV) free wall rupture is a serious complication of acute myocardial infarction that may result in acute cardiac tamponade and sudden death. Many surgeons have recently reported that sutureless repair using TachoComb® sheets can efficiently achieve hemostasis [3,5,6,11]. This strategy is not usually suitable for blowout ruptures, where the myocardial tear is often large and bleeding is copious [1,2,3]. Nishizaki et al [11] reported successful sutureless repairs with use of the TachoComb® sheet for a blowout rupture from a 1-cm tear, the risks of such an approach are possible future complications such as pseudoaneurysm and rerupture [5,6]. The advantages of sutureless repairs with TachoComb® sheets include rapid hemostasis without the need for
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