Surgical repair of postinfarction ventricular septal rupture: Risk factors of early and late death

Abstract

Early outcome after repair of ventricular septal rupture improved significantly during time, with 30-day mortality being 21% in the last decade. Five- and 10-year cumulative survival was 50% and 32%, respectively. Shock at surgical intervention and incomplete coronary revascularization were strong and independent predictors of poor early and late survival.

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

“…Prolonged CPB time was found to be a risk factor of overall mortality in several previous studies [5,6]. However, prolonged CPB time was not a predictor of cumulative mortality in 30-day survivors in the cited study [6], and the authors suggested that the prolonged CPB might have been confounded by underlying factors.…”

“…Although a recent report demonstrated a significant improvement of surgical outcomes in the second half of the 25-year study period [6], there were no remarkable changes in the surgical outcomes of post-infarct VSD in the other previous studies [1-5,7-18]. The dismal outcomes may be attributable to the disease nature of post-infarct VSD: the surgical outcomes of post-infarct VSD are predominantly affected by the preoperative patients' hemodynamic stability.…”

“…It has been commonly believed that if patients are hemodynamically stable, surgical repair should be delayed until the formation of the myocardial scar tissue and the development of the margins of the infracted muscle because the myocardium is considerably fragile; this may facilitate technical aspects of the surgical procedure. However, a majority of the studies demonstrated no association of the surgical timing of VSD and the surgical outcomes [3,6,11-13], and the current guideline of American College of Cardiology/American Heart Association recommends immediate repair of post-infarct VSD after diagnosis without delay, irrespective of the hemodynamic status because rapid deterioration can occur in many patients [19]. The association of the earlier surgical timing and operative mortality in some reports may be mostly attributable to the hemodynamic status requiring earlier surgery, not to the technical difficulty.…”

“…However, prolonged CPB time was not a predictor of cumulative mortality in 30-day survivors in the cited study [6], and the authors suggested that the prolonged CPB might have been confounded by underlying factors. In our study, prolonged CPB time was an independent factor associated with overall mortality in the multivariable analysis.…”

Using Extracorporeal Membrane Oxygenation Support Preoperatively and Postoperatively as a Successful Bridge to Recovery in a Patient with a Large Infarct-Induced Ventricular Septal Defect

“…Th e ideal timing of VSD repair is a point for debate ( Table 1 ) ( 2,5,9,(12)(13)(14). A few studies support our current strategy of delaying surgery, allowing optimization of medical management prior to intervention if permissible.…”