A Graded Approach to the Management of Penetrating Wounds of the Heart

An analysis of 58 “unselected” penetrating wounds of the heart discloses the following: Twenty-one “lifeless patients” received immediate thoracotomy and repair; seven survived. Thirty-three with frank hemorrhage or progressive tamponade were treated by urgent cardiorrhaphy; 24 survived. Four were classified as having stable tamponade and were treated by pericardiocentesis; all four survived. Unfavorable influences on survival were gunshot wounds (as opposed to stab wounds), left ventricular wounds, coronary artery wounds, and associated abdominal injuries. Where available, cardiopulmonary bypass and circulatory assist devices should be kept on standby, for use in those patients with intracardiac and coronary injuries who would not survive without the help of extracorporeal circulation or postoperative support of a failing circulation.