Post-infarction ventricular septal defect: percutaneous or surgical management in the UK national registry

Abstract

Aims Post-infarction ventricular septal defect (PIVSD) is a mechanical complication of acute myocardial infarction (AMI) with a poor prognosis. Surgical repair is the mainstay of treatment, although percutaneous closure is increasingly undertaken. Methods and resuts Patients treated with surgical or percutaneous repair of PIVSD (2010–2021) were identified at 16 UK centres. Case note review was undertaken. The primary outcome was long-term mortality. Patient groups were allocated based upon initial management (percutaneous or surgical). Three-hundred sixty-two patients received 416 procedures (131 percutaneous, 231 surgery). 16.1% of percutaneous patients subsequently had surgery. 7.8% of surgical patients subsequently had percutaneous treatment. Times from AMI to treatment were similar [percutaneous 9 (6–14) vs. surgical 9 (4–22) days, P = 0.18]. Surgical patients were more likely to have cardiogenic shock (62.8% vs. 51.9%, P = 0.044). Percutaneous patients were substantially older [72 (64–77) vs. 67 (61–73) years, P < 0.001] and more likely to be discussed in a heart team setting. There was no difference in long-term mortality between patients (61.1% vs. 53.7%, P = 0.17). In-hospital mortality was lower in the surgical group (55.0% vs. 44.2%, P = 0.048) with no difference in mortality after hospital discharge (P = 0.65). Cardiogenic shock [adjusted hazard ratio (aHR) 1.97 (95% confidence interval 1.37–2.84), P < 0.001), percutaneous approach [aHR 1.44 (1.01–2.05), P = 0.042], and number of vessels with coronary artery disease [aHR 1.22 (1.01–1.47), P = 0.043] were independently associated with long-term mortality. Conclusion Surgical and percutaneous repair are viable options for management of PIVSD. There was no difference in post-discharge long-term mortality between patients, although in-hospital mortality was lower for surgery.

Impella Support for Surgical Ventricular Septal Defect Repair

“…Post-MI VSD is a fatal complication of myocardial ischemia and surgical closure is the gold-standard treatment. 1,8,11 Superior surgical outcomes are achieved by delaying repair, but patients are often hemodynamically unstable. Mechanical devices may allow delay of surgical intervention.…”

“…A rare, life-threatening complication of myocardial infarction (MI) is acute ventricular septal defect (VSD), with an incidence of 0.17–0.31%. 1,2 The infarcted septum ruptures, causing a left-to-right shunt and cardiogenic shock. Medical treatment with inotropes increases blood pressure and cardiac output but may increase left-to-right shunt and pulmonary pressures.…”

“…6 Transcatheter device closure is an alternative for selected patients in centers with appropriate expertise. 1 Surgical correction is definitive treatment. Long-term survival otherwise is rare.…”

Incidence, management, and prognosis of post-ischaemic ventricular septal defect: Insights from a 12-year tertiary centre experience

“…They did not find a difference in long-term mortality between patients managed by surgical or percutaneous closure (61.1% vs. 53.7%, p = 0.17), but in-hospital mortality was lower in the surgical group (55.0% vs. 44.2%, p = 0.048). Interestingly, the percutaneous approach [aHR 1.44 (1.01–2.05), p = 0.04], and the number of vessels with coronary artery disease [aHR 1.22 (1.01–1.47), p = 0.043] were two of the three independent factors associated with long-term mortality, suggesting better results for the surgical approach ( 26 ). Surgery and percutaneous closure should not be opposed but may be combined since 16.1% of percutaneous patients subsequently had surgery and 7.8% of surgical patients subsequently had percutaneous treatment.…”

Assessment of Post-Infarct Ventricular Septal Defects Through 3D Printing and Statistical Shape Analysis

“…Devices such as the AMPLATZER™ Post-infarct Muscular VSD Occluder have shown 61% event-free survival at 5 years [ 9 ]. Like surgical closure, delayed percutaneous occlusion has been shown to be of benefit to patient outcomes [ 10 ]. Delayed intervention in these patients allows for a window for joint surgical and cardiology meetings to plan management options.…”