Long-term efficacy of transcatheter closure of ventricular septal defect in combination with percutaneous coronary intervention in patients with ventricular septal defect complicating acute myocardial infarction: a multicentre study

Abstract

The combination of transcatheter VSD closure and PCI for treating VSD complicating AMI is safe and feasible and is a promising alternative to surgery in patients with anatomically suitable VSD and coronary lesion.

Management and Outcome of Ventricular Septal Rupture Complicating Acute Myocardial Infarction: What Is New in the Era of Percutaneous Intervention?

“…Although current guidelines recommend immediate intervention in patients with PI-VSR regardless of their clinical status [11, 12], the majority of percutaneous closures were performed during the subacute or chronic phase [4, 8, 10]. In our series, among the 19 acute-phase survivors who had relatively stable hemodynamics and underwent successful closure, only 4 (21%) died before discharge.…”

“…In our series, among the 19 acute-phase survivors who had relatively stable hemodynamics and underwent successful closure, only 4 (21%) died before discharge. In a prospective analysis, Zhu et al [8] reported a mortality of only 10% in 22 PI-VSR patients post percutaneous closure during the subacute or chronic phase. Similarly, Xu et al [10] reported a 97% procedure success rate in 33 PI-VSR patients at subacute or chronic phase.…”

“…The timing of PCI and antiplatelet therapy was at the physicians’ discretion. Usually, VSD closure was performed prior to PCI, but PCI would proceed closure if the patient presented with unstable angina and if coronary angiography showed a culprit lesion in proximal vessels with a heavy thrombosis burden [8]. All patients received standardized treatment for AMI [11, 12]; the PCI strategy and antiplatelet therapy were performed at the discretion of the physician.…”

“…The current ST-elevation myocardial infarction (STEMI) guidelines of the European Society of Cardiology (ESC) and the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) recommend urgent PI-VSR closure irrespective of hemodynamic status [11, 12], but the timing of PI-VSR closure and perioperative therapeutic management remain controversial [13]. In previous studies, most percutaneous device closures were performed during the subacute and chronic periods (≥2 weeks) after the initial detection of PI-VSR [4, 8, 10, 14]. The mortality associated with delayed percutaneous closure (≥2 weeks after PI-VSR detection) was reported to be 6.1–10.0% [8, 10], while mortality after early closure (< 2 weeks after PI-VSR occurrence) was as high as 66% [6].…”

“…In previous studies, most percutaneous device closures were performed during the subacute and chronic periods (≥2 weeks) after the initial detection of PI-VSR [4, 8, 10, 14]. The mortality associated with delayed percutaneous closure (≥2 weeks after PI-VSR detection) was reported to be 6.1–10.0% [8, 10], while mortality after early closure (< 2 weeks after PI-VSR occurrence) was as high as 66% [6]. This is likely explained by a selection bias, so the patients considered too sick to wait for delayed closure and those who died during the waiting period need to be identified.…”