Increased number of ventricular septal rupture cases after acute myocardial infarction in 2020

Abstract

Introduction: Ventricular septal rupture (VSR) is a serious mechanical complication after acute coronary syndrome and is related to high mortality. Even with advances in the management of acute myocardial infarction (AMI) such as reperfusion therapies, complication rates are still high. During quarantine, patients presenting mechanical complications after AMI have increased in our institution.Methods: From a retrospective database analysis in our institution between the years 2004 and 2020, we identified 37 cases of VSR after AMI. Four chronic cases were excluded from our analysis. The primary endpoint was to identify baseline characteristics that increased 30-day mortality.Results: Among 33 acute cases of VSR, 24 cases were submitted to surgery. The 30-day mortality of the operated patients was 45.8%. From 2004 to 2019 our average number of operations of VSR was 1.9 cases/year with an increase to 4 cases/year in 2020. Diabetes mellitus, age, cardiogenic shock, and use of intraaortic balloon pump were associated with significantly increased mortality using logistic regression. Conclusion:We reported an increased number of mechanical complication cases from April to September 2020, compared to our historical records. Despite therapeutic advances, mortality rates remain high. Although the number of cases is small to conclude that the pandemic was responsible for this augmentation, we believe that it is related to the decreased number of patients seeking medical assistance.

A new dimension to the STEMI-related mortality risk seen in the COVID-19 pandemic era

“…Furthermore, in that review, the mortality rate for VSR was as high as 54.6% [ 3 ]. A comparable trend was demonstrated by data from another institution, whereby, with the onset of the COVID-19 pandemic, the average number of operations for VSR increased to 4 cases/year, having been as low as 1.9 cases/year in previous years [ 4 ].…”

Impact of COVID‐19 on coronary artery surgery: Hard lessons learned

“…A large number of operations were canceled or postponed due to interruptions caused by COVID‐19. Coincidentally, our institution have reported an increased number of mechanical complications, that maybe related to decreased number of patients seeking for medical assistance 16 …”

“…Coincidentally, our institution have reported an increased number of mechanical complications, that maybe related to decreased number of patients seeking for medical assistance. 16 Studies conducted in the first months of the pandemic showed that if countries increased their normal surgical volume by 20%, it would take an average of 45 weeks to balance the backlog of operations resulting from the interruption of COVID-19. 9 Patients awaiting elective cardiac surgery need to be proactively managed, reprioritizing those with high-risk anatomy or whose clinical status is deteriorating.…”

Impact of COVID-19 on incidence and outcomes of post-infarction mechanical complications in Europe

“…Moreover, only one patient got COVID-19 infection during hospital stay, that later represented the cause of death. Therefore, despite the sometimes-advocated fear of getting COVID-19 on hospitalization during the pandemic peak, it is reasonable to conclude that, with proper safety measures, quickly reaching a tertiary centre in the presence of complicated AMI, does not represent an additional risk for hospital-acquired infection [ 9 ].…”