ACUTE MANAGEMENT OF COMPLEX CARDIAC INJURIES

Background: Injury to the heart has been studied extensively, However, a small group of patients with injuries to the coronary arteries or i ntracardiac structures may require a different operative approach, Met hods: Retrospective review of a cardiovascular injury database. Result s: Over a 20-year period, 711 cardiac injuries were treated. The mean age of the victims was 31.1 (90% men), Causes were primarily stab woun ds (54%) and gunshot wounds (42%), Cardiac chambers injured included t he right ventricle (40%), left ventricle (40%), right atrium (24%), an d left atrium (3%), The overall mortality was 47%, Sixty complex injur ies occurred, Of 21 left anterior descending coronary artery injuries (76.2% mortality), two patients presented with sufficient signs of lif e to warrant emergent coronary artery bypass (mortality 50%), There we re seven circumflex/obtuse marginal coronary artery injuries, all trea ted with ligation (mortality 71.4%), Eight right/posterior descending coronary artery injuries (mortality 62.5%) were seen, and all but one were treated with ligation, The one patient not treated with ligation underwent coronary bypass and died, Delayed mitral valve replacement w as performed for two valvular injuries (mitral), There were a total of 14 intracardiac fistulas (mortality 35.7%), All six of the surviving patients with ventricular septal defect required reoperation, Conclusi on: The mortality for complex injuries (coronary, septal, valvular) wa s 53%, This group was a specific population that self-selected by surv iving to operation, Acute operations for complex injuries (beyond card iorrhaphy) were primarily heroic life-saving efforts, Reoperation for cardiac injuries was most common for septal or valvular injuries, Only 2% of all survivors required reoperation to correct a residual defect .