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

Abstract

Background: Postinfarction ventricular septal rupture (PI-VSR) is a rare but devastating complication of acute myocardial infarction (AMI). Risk stratification in the acute phase is crucial for decision-making, and this study analyzed the risk factors for early mortality and the effects of various management options on the outcome of PI-VSR patients in the era of percutaneous intervention. Methods: A total of 96 patients with PI-VSR were identified and divided into an acute-phase survivor group (n = 46, survived ≥2 weeks after admission) and a nonsurvivor group (n = 50, died within 2 weeks after admission). Percutaneous closure was considered in acute-phase survivors. Patients were followed up for a mean 47 (quartiles 15–71) months by clinical visit or telephone interview. Results: The overall acute-phase (i.e., < 2 weeks after the diagnosis of PI-VSR) mortality rate was 52%. Female sex and Killip Class III–IV at admission were associated with an increased risk of acute-phase death. Of the 46 patients who survived ≥2 weeks, 20 underwent interventional occlusion and the procedure was successful in 19. Percutaneous closure in the acute-phase survivor group improved the immediate (21% in-hospital mortality rate) and long-term (53% mortality) outcomes. Conclusions: Patients with PI-VSR are at a high risk of acute-phase mortality. Female sex and severe cardiac dysfunction at admission are linked with a high rate of acute-phase deaths. Percutaneous closure in acute-phase survivors results in favorable short- and long-term benefits for PI-VSR patients.

Did COVID-19 Pandemic Increase Mechanical Complications of ST Elevation Myocardial Infarction? Are We Returning Back to Pre-Thrombolytic Era?

“…Tricuspid regurgitation murmur may also be present. The diagnosis can easily be made by physical examination and echocardiography in almost 100% of the patients (7,8).…”

“…Early surgery is associated with a high mortality rate, reported as 20-40%, and a high risk of recurrent ventricular rupture (8). However, cardiovascular surgeons assert that delayed surgery allows more natural septal repair in scarring tissue (9); this approach carries the risk of rupture extension and death while waiting for surgery (8).…”

Acute mechanical complications in patients suffering from acute myocardial infarction

“…Other techniques involve infarct exclusion and defect closure with a patch (biological or synthetic) using both stitches or glues [40,41] . Despite continuous advances in surgical approaches, operative mortality remains high (ranging from 20% to 71.4%), with no clear differences between different techniques [41][42][43] . Female gender and depressed left ventricular dysfunction at admission are linked with a high hospital death [43] .…”

“…Despite continuous advances in surgical approaches, operative mortality remains high (ranging from 20% to 71.4%), with no clear differences between different techniques [41][42][43] . Female gender and depressed left ventricular dysfunction at admission are linked with a high hospital death [43] . Table 2 reports the in-hospital mortality rates and long-term survival percentages of studies with relatively large number of patients.…”

“…Percutaneous closure of the VSD remains an attractive alternative to surgical repair mainly in extremely high-risks patients with reasonable results. Despite the in-hospital mortality is graved from a relatively high incidence (from 20% up to 46%), the patients who survived to discharged had a very acceptable longterm survival [43,49] .…”