The journal of trauma and acute care surgery · 2026
A retrospective observational study on management of penetrating gunshot and migrating projectile injuries to the heart during the war in Ukraine.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
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Maruniak Stepan, Hutsuliak Yurii, Mokryk Ihor, Zelenchuk Oleh, Sudakevych Serhii, Kuzmich Ihor, Batchinsky Andriy, Swol Justyna, Todurov Borys, Kyiv, Ukraine
Аннотация
BACKGROUND: Penetrating cardiac injuries caused by firearms are associated with extremely high prehospital and early in-hospital mortality. During wartime, civilian cardiac surgery centers are increasingly involved in the management of complex gunshot and fragment-related cardiac injuries, yet published evidence from nonmilitary practice remains limited.
METHODS: We conducted a retrospective observational study of civilian and military patients with penetrating cardiac gunshot or fragment injuries treated surgically at a tertiary civilian cardiac surgery center between February 2022 and December 2025. Patients with severe cardiogenic shock or rapidly progressing tamponade were typically managed at frontline hospitals; referred patients who survived initial resuscitation underwent definitive cardiac surgery at our institution. Demographic, clinical, imaging, operative, and outcome data were analyzed descriptively.
RESULTS: Among 69 patients undergoing cardiac surgery for combat-related injuries, 25 required surgical removal of intracardiac foreign bodies. Median age was 38 years [interquartile range (IQR): 32-47], and 92% were males; 72% were military personnel. Metallic fragments accounted for 92% of foreign bodies, most commonly located in the ventricles. All procedures were performed in a hybrid operating room; cardiopulmonary bypass was used in 32% of cases, while 68% were managed off-pump with bypass standby. Neodymium magnet-assisted extraction was used in 80% of procedures. Median operative time was 117 minutes (IQR: 89-133). Median intensive care unit stay was 3 days (IQR: 2-5), and hospital stay was 13 days (IQR: 8-17). In-hospital and 30-day mortality were both 4%.
CONCLUSIONS: Surgical management of penetrating cardiac gunshot and fragment injuries can be safely performed in civilian cardiac surgery centers during wartime. A multimodal imaging strategy, individualized use of cardiopulmonary bypass, hybrid operating room infrastructure, and adjunctive magnet-assisted techniques facilitate effective treatment with favorable early outcomes. ( J Trauma Acute Care Surg . 2026;101: S52-S57. Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.).
LEVEL OF EVIDENCE: Therapeutic/care management, Level IV.
METHODS: We conducted a retrospective observational study of civilian and military patients with penetrating cardiac gunshot or fragment injuries treated surgically at a tertiary civilian cardiac surgery center between February 2022 and December 2025. Patients with severe cardiogenic shock or rapidly progressing tamponade were typically managed at frontline hospitals; referred patients who survived initial resuscitation underwent definitive cardiac surgery at our institution. Demographic, clinical, imaging, operative, and outcome data were analyzed descriptively.
RESULTS: Among 69 patients undergoing cardiac surgery for combat-related injuries, 25 required surgical removal of intracardiac foreign bodies. Median age was 38 years [interquartile range (IQR): 32-47], and 92% were males; 72% were military personnel. Metallic fragments accounted for 92% of foreign bodies, most commonly located in the ventricles. All procedures were performed in a hybrid operating room; cardiopulmonary bypass was used in 32% of cases, while 68% were managed off-pump with bypass standby. Neodymium magnet-assisted extraction was used in 80% of procedures. Median operative time was 117 minutes (IQR: 89-133). Median intensive care unit stay was 3 days (IQR: 2-5), and hospital stay was 13 days (IQR: 8-17). In-hospital and 30-day mortality were both 4%.
CONCLUSIONS: Surgical management of penetrating cardiac gunshot and fragment injuries can be safely performed in civilian cardiac surgery centers during wartime. A multimodal imaging strategy, individualized use of cardiopulmonary bypass, hybrid operating room infrastructure, and adjunctive magnet-assisted techniques facilitate effective treatment with favorable early outcomes. ( J Trauma Acute Care Surg . 2026;101: S52-S57. Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.).
LEVEL OF EVIDENCE: Therapeutic/care management, Level IV.