Long-Term Results After Surgical Repair of Postinfarction Ventricular Septal Rupture by Infarct Exclusion Technique

Papadopoulos, Nestoras; Moritz, Anton; Dzemali, Omer; Zierer, Andreas; Rouhollapour, Amin; Ackermann, Hanns; Bakhtiary, Farhad

doi:10.1016/j.athoracsur.2009.02.011

Cited by 57 publications

(47 citation statements)

References 22 publications

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“…Surgical difficulties in the exposure of the septal rupture site and the right heart failure are mainly attributed to poor prognosis. However, David et al [7] and a recent report [8] showed a different result; they revealed that posterior VSD is significantly associated with improved surgical outcomes. The authors suggest that the infarct exclusion technique may address the difficulties of posterior VSD repair and prevent right heart failure by the physiologically sound character of the technique.…”

Section: Discussionmentioning

confidence: 99%

Surgical Repair of Ventricular Septal Defect after Myocardial Infarction: A Single Center Experience during 22 Years

Park

Kim

Jung

et al. 2013

Korean J Thorac Cardiovasc Surg

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BackgroundSurgical repair of post-infarct ventricular septal defect (VSD) is considered one of the most challenging procedures having high surgical mortality. This study aimed to evaluate the outcomes of the surgical repair of post-infarct VSD.MethodsFrom May 1991 to July 2012, 34 patients (mean age, 67.1±7.9 years) underwent surgical repair of post-infarct VSD. A retrospective review of clinical and surgical data was performed.ResultsVSD repair involved the infarct exclusion technique using a patch in all patients. For coronary revascularization, 12 patients (35.3%) underwent concomitant coronary artery bypass graft, 3 patients (8.8%) underwent preoperative percutaneous coronary intervention, and 9 patients (26.5%) underwent both of these procedures. The early mortality rate was 20.6%. Six patients (17.6%) required reoperation due to residual shunt or newly developed VSD. During follow-up (median, 4.8 years; range, 0 to 18.4 years), late death occurred in nine patients. Overall, the 5-year and 10-year survival rates were 54.4%±8.8% and 44.3%±8.9%, respectively. According to a Cox regression analysis, preoperative cardiogenic shock (p=0.069) and prolonged cardiopulmonary bypass time (p=0.008) were independent predictors of mortality.ConclusionThe early surgical outcome of post-infarct VSD was acceptable considering the high-risk nature of the disease. The long-term outcome, however, was still dismal, necessitating comprehensive optimal management through close follow-up.

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Section: Discussionmentioning

confidence: 99%

Surgical Repair of Ventricular Septal Defect after Myocardial Infarction: A Single Center Experience during 22 Years

Park

Kim

Jung

et al. 2013

Korean J Thorac Cardiovasc Surg

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“…4 This introduces a significant selection bias into surgical series, artificially inflating survival rates. [5][6][7][8] The advent of the Amplatzer family of ventricular septal defect (VSD) closure devices offers a potentially attractive alternative to surgical repair with multiple device implants possible if required ( Figure 1A). A few series of selected cases exist, with good results reported, [9][10][11] but there are no large series with early as well as delayed intervention.…”

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confidence: 99%

Percutaneous Closure of Postinfarction Ventricular Septal Defect

et al. 2014

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Background-Postinfarction ventricular septal defect carries a grim prognosis. Surgical repair offers reasonable outcomes in patients who survive a healing phase. Percutaneous device implantation represents a potentially attractive early alternative. Methods and Results-Postinfarction ventricular septal defect closure was attempted in 53 patients from 11 centers (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012); aged 72±11 years; 42% female). Nineteen percent had previous surgical closure. Myocardial infarction was anterior (66%) or inferior (34%). Time from myocardial infarction to closure procedure was 13 (first and third quartiles, 5-54) days. Devices were successfully implanted in 89% of patients. Major immediate complications included procedural death (3.8%) and emergency cardiac surgery (7.5%). Immediate shunt reduction was graded as complete (23%), partial (62%), or none (15%). Median length of stay after the procedure was 5.0 (2.0-9.0) days. Fifty-eight percent survived to discharge and were followed up for 395 (63-1522) days, during which time 4 additional patients died (7.5%).

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“…3 Since the original description of post-AMI VSR in 1957, surgical closure remains a challenging procedure with mortality rates between 20% and 87%. [4][5][6] Expert opinion and professional guidelines suggest that immediate closure should be considered to reduce the duration of poor systemic perfusion that results from left-to-right shunting, pulmonary over circulation, and systemic hypoperfusion that may eventuate in refractory multiple organ failure and death. 7 Despite this awareness, there is a tendency for surgeons to wait several weeks before operating to allow tissue healing and more complete rupture remodeling, contributing to high interstage mortality and positive selection of more favorable cases.…”

mentioning

confidence: 99%

Transcatheter Closure of Post-myocardial Infarction Ventricular Septal Rupture

Assenza

McElhinney

Valente

et al. 2013

Circ: Cardiovascular Interventions

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Background-Ventricular septal rupture (VSR) after acute myocardial infarction (AMI) is a potentially lethal mechanical complication of acute coronary syndromes. Given high surgical mortality, transcatheter closure has emerged as a potential strategy in selected cases. We report our single-center experience with double-umbrella device percutaneous closure of post-AMI VSR. Methods and Results-In this single-center, retrospective, cohort study, patients who underwent transcatheter closure of post- AMI VSR between 1988 and2008 at Boston Children's Hospital were included. Data were analysed according to whether the patients underwent direct percutaneous VSR closure or closure of a residual VSR after a previous surgical approach. Primary outcome was mortality rate at 30 days. Clinical predictors of primary outcome were investigated using univariate logistic regression. Thirty patients were included in the study (mean age, 67±8 years). A total of 40 closure devices were implanted. Major periprocedural complications occurred in 4 (13%) patients. Cardiogenic shock, increasing pulmonary/ systemic flow ratio, and the use of the new generation (6-arm) STARFlex device all were associated with higher risk of mortality. The Model for End-Stage Liver Disease Excluding international normalized ratio (MELD-XI) score at the time of VSR closure seemed to be most strongly associated with death (odds ratio, 1.6; confidence interval, 1.1-2.2; P<0.001). Conclusions-Transcatheter closure of post-AMI VSR using CardioSEAL or STARFlex devices is feasible and effective.The MELD-XI score, a marker of multiorgan dysfunction, is a promising risk stratifier in this population of patients. as definitive single therapy, as a bridge to surgery, or for closure of residual defects after surgical repair in selected cases. [8][9][10] To date, the majority of studies of transcatheter closure of post-AMI VSR have reported on the use of Amplatzer atrial septal defect and ventricular septal defect occluders (AGA Medical Corporation, Plymouth, MN). 8-10Recent studies have investigated the utility of the Model for End-Stage Liver Disease (MELD) score as a potential predictor of poor outcomes in patients with heart disease.11,12 A logarithmic function of creatinine, total bilirubin, and international normalized ratio, the MELD score in many ways serves as a simpler marker of multiple organ dysfunction. The modified MELD score Excluding international normalized ratio (MELD-XI score) was validated against the original MELD score and has been shown to be equally able to predict mortality in patients with liver cirrhosis waiting for liver transplantation. 13In this study, we report the outcomes of transcatheter closure of post-AMI VSR using different double-umbrella devices in a consecutive cohort of patients referred during the course of 2 decades to our institution. Methods PopulationIn this single-center, retrospective, cohort study, patients referred to our institution for transcatheter closure of post-AMI VSR between 1988 and 2008 were included. Patients w...

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Long-Term Results After Surgical Repair of Postinfarction Ventricular Septal Rupture by Infarct Exclusion Technique

Cited by 57 publications

References 22 publications

Surgical Repair of Ventricular Septal Defect after Myocardial Infarction: A Single Center Experience during 22 Years

Surgical Repair of Ventricular Septal Defect after Myocardial Infarction: A Single Center Experience during 22 Years

Percutaneous Closure of Postinfarction Ventricular Septal Defect

Transcatheter Closure of Post-myocardial Infarction Ventricular Septal Rupture

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