Fifteen-year surgical experience with penetrating cardiac injury in Vietnam: A retrospective observational study of management and outcomes

Penetrating cardiac injury (PCI) is rare; however, it poses a significant challenge during emergency surgery. This study retrospectively analyzed cases of PCI to provide insights into management strategies and outcomes. A retrospective observational study was conducted on 43 patients with PCI who underwent surgical management at our institution between 2008 and 2023. Eligible cases included patients who were alive upon hospital admission and had PCI confirmed intraoperatively during thoracotomy. Patients with incomplete or missing clinical records were excluded. Demographic, intraoperative, and postoperative variables were extracted for analysis. The mean age was 33.8 ± 15.1 (15-80). Most patients had stabbed penetrating wounds (88.4%). The time from the injury to the hospital was 70 minutes. PCI at the region of "cardiac box" accounted for 83.7%. Hemorrhagic shock and cardiac tamponade upon arrival at the hospital occurred in 60% and 62% of the patients, respectively. Median sternotomy and left anterolateral thoracotomy were the most frequently used procedures, accounting for 97.7%. The most frequent injuries were simple wounds of the right ventricle (46.5%) and simple wounds of the left ventricle (27.9%). Intraoperative blood transfusion volume was 1513.1 ± 984.6 mL. Of 43 patients, 37 survived to hospital discharge (86.0%), while 6 patients died (4 intraoperatively and 2 postoperatively. Postdischarge follow-up revealed interventricular septal hypokinesia in 3 patients and a conal ventricular septal defect in one patient. This retrospective observational study delineates the surgical management and outcomes of PCI at a tertiary institution in Vietnam. While highlighting the importance of timely surgical intervention, its retrospective and observational nature limits causal interpretation. Further prospective studies are needed to confirm these findings and guide standardized management.