In-Hospital Outcomes and Long-Term Follow-Up after Percutaneous Transcatheter Closure of Postinfarction Ventricular Septal Defects

Abstract

Postinfarction ventricular septal defects (VSD) represent a devastating complication of acute myocardial infarction and are associated with high mortality. Percutaneous interventional closure of postinfarction VSD has been proposed as a potential alternative to surgery. The study aimed to evaluate the therapeutic safety and efficacy of percutaneous interventional closure of postinfarction ventricular septal defects (VSD). Each patient was assigned to one of two groups, based on whether they died during hospitalization (death group) or survived (survival group) in this retrospective study. In-hospital and follow-up data were analyzed. Placement of the VSD occluder was successful in 12 procedures (80%). The mean defect size was 14.20 ± 4.89 mm. Compared to the patients who died, those who survived had higher systolic blood pressure, diastolic blood pressure, and left ventricular ejection fraction upon admission, as well as lower pulmonary/systemic flow ratio and shorter time from acute myocardial infarction to procedure. The incidence of cardiac shock and class IV heart failure was lower in the survival group than in the death group, and these factors correlated with in-hospital and 30-day mortality. Percutaneous closure of postinfarction VSD is an effective technique, which can be performed with a high procedural success rate.

Transcatheter closure for postinfarction ventricular septal defect: A meta‐analysis of the current evidence

“…For the best timing of TCC after AMI, there were two contrary opinions. Most people believe that a delay of 10–14 days may help shape the scarred tissue to restore the perforation tissue and improve the NYHA classification to acquire a better progression 16 . Others consider percutaneous closure to be performed as quickly as possible because prolonging the time was not associated with low mortality 15…”

“…Most people believe that a delay of 10-14 days may help shape the scarred tissue to restore the perforation tissue and improve the NYHA classification to acquire a better progression. 16 Others consider percutaneous closure to be performed as quickly as possible because prolonging the time was not associated with low mortality. 15 The location and size of the device were detected by twodimensional transthoracic echocardiography (2DTTE) in a large number of studies, with a sizing balloon to determine the size in minor cases.…”

“…Individual analyses of predictors of mortality after transcatheter PIVSD closure based on the random effect model showed good results. Mortality after CS was evaluated in four studies, [15][16][17][18] and CS was associated with an increased risk of mortality (OR = 3.607, 95% CI: 2.301-5.653; p = .000) (Figure 3A). Zhang et al and Calvert et al showed that NYHA class IV increased the risk of mortality (OR = 6.491, 95% CI: 1.444-29.188; p = .015) (Figure 3B) and was similar in prolonging the time of PIVSD closure (OR = 0.850, 95% CI: 0.737-0.980; p = .025) (Figure 3C).…”

Systematic review and meta-analysis of the mechanical complications of ischemic heart disease: papillary muscle rupture, left ventricle rupture and post-infarct ventricular septal defect

“…Procedural success was reliably reported in 21 studies (42)(43)(44)(45)(46)(47)50,(52)(53)(54)(55)(56)(58)(59)(60)(61)(62)(63)(64)(65)(66). There were 43 failed procedures in 314 patients.…”

“…There was no evidence of publication bias on visual inspection of funnel plots (Egger's regression test, P=0.41). Presence of post-procedural shunt was reported in 15 studies (43,45,46,50,53,54,(56)(57)(58)(61)(62)(63)(64)(65)(66). 21 out of 225 patients demonstrated a moderate or severe shunt at the time of discharge.…”