Outcomes of surgical repair of anterior or posterior ventricular septal rupture after myocardial infarction

Abstract

Background: Ventricular septal rupture (VSR) is a rare and fatal complication of myocardial infarction.Surgery is the main treatment for the condition. It is currently believed that surgery is less effective for posterior VSR than for anterior VSR. The objective of this study was to investigate the clinical outcomes of surgical treatment for myocardial infarction combined with an anterior or posterior VSR.Methods: This was a single-center, retrospective, observational, cohort study. Clinical data of 68 patients with myocardial infarction combined with VSR were retrospectively analyzed. According to the site of the VSR, patients were divided into the anterior (43 cases) and posterior (25 cases) VSR groups, and the general clinical data, preoperative examination results, surgery, and follow-up results were compared between the two groups.Results: Compared with the anterior VSR group, the operative time in the posterior VSR group was longer {300 [240, 360] vs. 360 [300, 400] min; P=0.003}, and the cardiopulmonary bypass time was longer (142.0±52.2 vs. 180.2±52.3 min; P=0.005), and the aortic clamp time was longer (84.0±32.5 vs. 115.9±39.8 min; P=0.001).There were no significant differences in the incidence of perioperative complications, including bleeding, low cardiac output, pulmonary, and cerebrovascular complications, and the incidence of perioperative death between the two groups (P>0.05). The patients were followed up for 1.0-10.5 (median, 4.2) years. There were no significant differences in the survival rate and the incidence of major adverse cardiovascular and cerebrovascular events (MACCEs) including myocardial infarction, heart failure, revascularization, and cerebrovascular events between the two groups (P>0.05). Conclusions:The perioperative risks and medium-and long-term outcomes of the surgical repair of anterior or posterior VSR after myocardial infarction were similar.

Risk of cardiac rupture among elderly patients with diabetes presenting with first acute myocardial infarction

“…However, in another study which enrolled 148881 aged patients (67-71 years) with first-onset STEMI, all were divided into the CR group (n=408, with free wall rupture) and the control group (n=148473, without CR). They found that the occurrence of DM history was significantly lower than that in the control group (18% vs. 24%), and DM was a protective factor of ventricular free wall rupture (OR=0.67,95%CI: 0.52-0.87) (14). Meanwhile, for patients with papillary muscle rupture or ventricular septum perforation, diabetes is more rare (15,16), and several published studies did not detect the association between DM and the risk of papillary muscle rupture or ventricular septum perforation (P>0.05).…”

“…Based on the analysis of 6712 STEMI patients in our research center, we found the neutrophil count ≥ 9 × 10 9 /L was an independent risk factor for ventricular free wall rupture, but DM was not an risk factor for CR. Diabetes is a common complication among elderly STEMI patients, which will significantly increase the risk of adverse cardiovascular events (14). Recently, we retrospectively analyzed a total of 10284 patients with STEMI admitted to Beijing Anzhen Hospital from January 2012 to March 2015.…”

Repair of posterior ventricular septal rupture by right atrial approach

“…Although several surgical interventions have been developed, mortality and complications associated with surgical management are still high, especially in terms of transventricular approaches. [2] Among these patients, anterior VSR (66%-78%) and posterior VSR accounted for about 17%-22%. [3] Compared with surgical repair of anterior VSR, the operative mortality of posterior VSR is higher.…”

“…[5] Exclusion of infarction by left ventriculotomy is an additional injury to already unstable myocardium. [2] There are several problems in ventriculotomy: (1) remodeling after MI and making a large incision on the free wall of the ventricle can affect postoperative low cardiac function and ventricular arrhythmia; and (2) larger sutures and tight closure of the ventricles also reduce the remaining ventricular volume and worsen the diastolic function of the heart. [6] Also, there was a technical obstacle of difficult dissection with uneasy access to the previous left ventriculotomy in this case, which was complicated by a patent coronary artery bypass graft.…”