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Formica et al. Vessel Plus 2019;3:37 I http://dx.doi.org/10.20517/2574-1209.2019.19 Page 3 of 10

Figure 1. Massive hemopericardium following “blow-out” left ventricular free wall rupture

Figure 2. Linear closure of a “blow-out” left ventricular free wall rupture (inferior wall)

[Figure 2] or infartectomy associated to closure of the defect with a prosthetic patch when the LVFWR is a
[3]
blow-out type ; (2) covering patch technique or sutureless technique (named also “patch and glue”) in case
of oozing LVFWR [Figure 3] . Operations can be performed with or without cardiopulmonary bypass.
[3,8]
Off-pump procedure is the technique of choice in case of oozing LVFWR and patients in stable conditions.
Some authors heave recently reported newer surgical strategies, usually performed in presence of oozing
by using different materials such as ready-to-use haemostatic collagen sponges [3,8,15] and newer acellular
xenogeneic extracellular matrix patches [Figure 4] .
[16]
Preoperative and postoperative insertion of IABP is advocated by some authors even when patients
presented in stable haemodynamic status, with the aim to reduce the oxygen demand, the left ventricle
wall tension and the left ventricle afterload [17,18] . This approach may reduce the risk of re-rupture during
the early postoperative period. In the last 20 years, ECMO has emerged as a rescue tool to warrant a rapid
haemodynamic stability in such patients presented with acute cardiogenic shock or even cardiac arrest [19,20] .
ECMO may be use also to stabilize patients affected by LVFWR in referring hospitals [21,22] . However, there is