Survival rates associated with surgical repair of ventricular free-wall rupture after acute myocardial infarction. Single-center experience

Introduction : Rupture of the free ventricular wall is a rare and catastrophic complication of acute myocardial infarction (AMI). Aim : The aim of this study was to present our experience in treating post-infarction ventricular free wall rupture by analyzing the relationship between preoperative risk factors and patient survival, and by comparing our perioperative outcomes with those reported in the scientific literature. Materials and methods : We conducted a retrospective analysis of data from 12 patients who underwent emergency surgery for ventricular free-wall rupture as a result of AMI. The study was conducted in the cardiac surgery department at Saint Anna University Hospital in Sofia from October 2014 to February 2025. Patients were categorized into two groups based on survival: group 1, survivors (nine patients); and group 2, non-survivors (three patients). Results : Significantly higher levels of creatine phosphokinase were observed in the non-survivor group ( p =0.021). Cardiogenic shock prior to entering the operating room was documented in 75% of patients; however, data do not demonstrate a correlation with survival. Preoperative controlled pericardiocentesis was required in 25% of cases to alleviate pericardial tamponade and allow time for life-saving surgery. Again, no significant correlation with survival was observed. The in-hospital mortality rate was 25%. Conclusion : Immediate surgical repair of the ventricular wall has a fundamental role in the therapeutic approach. The choice of surgical technique remains individualized based on the specific patient, with no significant correlation to survival. Creatine phosphokinase levels may serve as a predictor of survival, but further studies are required to confirm this trend.