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Left ventricular free-wall rupture (LVFWR) is an uncommon but serious mechanical complication of acute myocardial infarction. Surgical repair, though challenging, is the only definitive treatment. Given the rarity of this condition, however, results after surgery are still not well established. The aim of this study was to review a multicenter experience with the surgical management of post-infarction LVFWR and analyze the associated early outcomes. Using the CAUTION (Mechanical Complications of Acute Myocardial Infarction: an International Multicenter Cohort Study) database, we identified 140 patients who were surgically treated for post–acute myocardial infarction LVFWR in 15 different centers from 2001 to 2018. The main outcome measured was operative mortality. Multivariate analysis was carried out by constructing a logistic regression model to identify predictors of postoperative mortality. The mean age of patients was 69.4 years. The oozing type of LVFWR was observed in 79 patients (56.4%), and the blowout type in 61 (43.6%). Sutured repair was used in the 61.4% of cases. The operative mortality rate was 36.4%. Low cardiac output syndrome was the main cause of perioperative death. Myocardial rerupture after surgery occurred in 10 patients (7.1%). Multivariable analysis revealed that preoperative left ventricular ejection fraction (P <.001), cardiac arrest at presentation (P =.011), female sex (P =.044), and the need for preoperative extracorporeal life support (P =.003) were independent predictors for operative mortality. Surgical repair of post-infarction LVFWR carries a high operative mortality. Female sex, preoperative left ventricular ejection fraction, cardiac arrest, and extracorporeal life support are predictors of early mortality. [ABSTRACT FROM AUTHOR]

This year marks the 60th anniversary of the first aortic and mitral valve replacements using mechanical artificial prosthesis. The first caged-ball devices represented a milestone in cardiac surgery and in the treatment of valvular disease. The following decades witnessed a great evolution in mechanical valve technology providing, through frustrating complications and stimulating successes, more reliable models to be safely used in the clinical setting. This review pays tribute to pioneers of this field who made currently available the most advanced models of mechanical prostheses with extended records of durability and performance, to be used as reliable alternatives to biological devices. [ABSTRACT FROM AUTHOR]

In patients with infective endocarditis (IE), splenic involvement is a rare but well-known adverse event. The treatment of patients with IE and splenic abscesses is still challenging and controversial. We report 3 patients with IE and splenic abscesses who underwent successful valve replacement and splenectomy. Our experience confirms that in such a patient, a valve operation combined with splenectomy can be performed with excellent results during the same hospitalization. The timing of splenectomy and the type of surgical approach should be based mainly on the stability of a patient’s hemodynamic condition. [ABSTRACT FROM AUTHOR]