Which strategy should be chosen for ischemic free wall rupture on-pump or off-pump?

In 2017, I reported sutureless repair as a treatment for ischemic heart rupture, and found that an offpump technique using fibrin glue sheets or other materials might contribute to excellent clinical results. In a similar case, Ishii and colleagues reported a patient who underwent sutureless repair with hemostat materials on the bleeding site without cardiopulmonary bypass. Even today, conventional repair under cardiopulmonary bypass leads to unsatisfactory results. A case of a huge pseudoaneurysm after such a repair of left ventricular wall rupture was reported. Although this kind of repair is a simple procedure for ischemic rupture of the left ventricle, clinicians should consider that it carries a potential risk of aneurysmal formation after surgery.