Operative Management of Cardiac Injuries: Diagnosis, Technique, and Postoperative Complications

Abstract

Penetrating cardiac injuries (PCI) are challenging in part because of their lethality and have thus long demanded the respect of physicians [1]. In the early eighteenth century, Boerhaeve designated all penetrating cardiac trauma as fatal [2]. In 1913, Dr. Billroth stated that Bany surgeon who would attempt operation on the heart should lose the respect of his colleagues.^ [3] In 1916, Dixon and McEwen proclaimed, BProbably nearly all cardiac wounds produce death from haemorrhage too quickly to allow the patient being removed alive even to a short distance from the battle field.^ [4] Despite such poor outcomes, attempts were made to salvage the injured patients. In 1829, Napolean’s surgeon D. J. Larrey described a Bnew surgical procedure to open the pericardium in the case of fluid in the cavity.^ [5] The first reported cardiac procedure is that of Alex Cappelen repairing a penetrating injury of the left ventricle through a left anterior thoracotomy in Christiania; the patient died 3 days later [6]. Numerous case reports [3, 7–29] and case series [1, 30–32, 33•, 34•, 35, 36•] have detailed the clinical presentation and treatment of various PCI in adults. This review will highlight the most recent advances and controversies in caring for this challenging patient population from pre-hospital management to definitive surgical treatment.