Surgical Repair of Postinfarction Ventricular Septal Rupture: Systematic Review and Meta-Analysis

Matteucci, Matteo; Ronco, Daniele; Corazzari, Claudio; Fina, Dario; Jiritano, Federica; Meani, Paolo; Kowalewski, Mariusz; Beghi, Cesare; Lorusso, Roberto

doi:10.1016/j.athoracsur.2020.08.050

Cited by 62 publications

(88 citation statements)

References 51 publications

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“… 6 In a recently published meta- analysis of 41 studies, Matteucci et al reported an operative mortality of 38.2% (2430 death out of 6,361 patients). 7 Reoperation was performed for residual or recurrent VSR in 7.4% of patients. The post-operative mortality is even higher in patients with RV dysfunction and patients with cardiogenic shock.…”

Section: Discussionmentioning

confidence: 99%

“…The post-operative mortality is even higher in patients with RV dysfunction and patients with cardiogenic shock. 7 , 8 In recent years percutaneous repair has been proposed as an alternative option in selected patients with high surgical risk and simple rupture amenable to percutaneous repair. 1 Schlotter et al in a meta-analysis of 13 studies showed a 30-day mortality of 32% (14-75%) in patients who underwent percutaneous repair.…”

Section: Discussionmentioning

confidence: 99%

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Ventricular septal rupture and cardiogenic shock complicating STEMI during COVID-19 pandemic: An old foe re-emerges

et al. 2021

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ventricular septal rupture and cardiogenic shock complicating STEMI during COVID-19 pandemic: An old foe re-emerges

et al. 2021

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“…The clinical effect varies depending on the size of the defect, its expansion over time, infarct area, degree of shunting, and severity of RV dysfunction. Nonetheless, the majority of patients develop hemodynamic deterioration in the hours or days following VSR [4,10].…”

Section: Discussionmentioning

confidence: 99%

“…The management of post-MI VSR is challenging and is associated with significant postoperative mortality [11]. Surgical repair is considered the treatment of choice, however, the optimal timing of surgery remains controversial, especially among hemodynamically unstable patients [10]. While the 2013 American College of Cardiology and American Heart Association Guidelines recommend emergent surgical repair in all VSR patients irrespective of hemodynamic status [12], a growing body of published data suggests improved survival with delay in VSR repair.…”

Section: Discussionmentioning

confidence: 99%

Post-Infarction Ventricular Septal Rupture Complicated by Cardiogenic Shock Requiring Mechanical Circulatory Support as a Bridge to Definitive Therapy During the COVID-19 Pandemic

Khorolsky¹,

Pettijohn²,

Yager³

2021

Cureus

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Ventricular septal rupture (VSR) is a devastating complication of acute myocardial infarction (MI) and is often associated with cardiogenic shock. Although considered to be very rare in the reperfusion era, recent reports have demonstrated an increased frequency of post-MI VSR cases during the COVID-19 pandemic. Despite advances in surgical repair and management strategies over the past decades, mortality rate has remained high, especially in hemodynamically unstable patients. In VSR patients with cardiogenic shock, the use of mechanical circulatory support (MCS) could be used as a bridge to surgical intervention. We report a patient with VSR complicated by cardiogenic shock secondary to late presenting MI, managed successfully with venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to surgical intervention.

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“…The authors are to be congratulated on this, as they should also be on a similar study in patients with interventricular septal rupture (VSR) after AMI, another complex post-infarction complication, very recently published in another Journal. 6 And the current paper is a complement of a paper on the same subject (LVFWR), also recently published, 7 on 140 patients from the CAUTION study database who were surgically treated for post-AMI LVFWR in 15 different centres from 2001 to 2018, from which they concluded that "surgical repair of post-infarction LVFWR carries a high operative mortality. Female gender, preoperative left ventricular ejection fraction, cardiac arrest, and extracorporeal life support, are predictors of early mortality", which differs little from the conclusions derived from the meta-analysis now made.…”

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confidence: 93%

Left ventricular free wall rupture -- a real nightmare

Antunes

2021

Preprint

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Left ventricular free wall rupture (LVFWR) is a most rare but often lethal mechanical complication of acute myocardial infarction (AMI). The mortality rate for LVFWR is described from 75% to 90% and it is the cause for 20% of in-hospital deaths after AMI. Death results essentially from the limited time available for emergent intervention after onset of symptoms. Emergency surgery is indicated and normally the rupture site is easily identified, but it may not be apparent macroscopically, corresponding to transmyocardial or subepicardial dissection with an external rupture far from the infarction site, or already thrombosed and contained. Repair of the ventricular wall is usually achieved either by suturing the edges of the tear or closing it with patches of artificial material or biological tissues, usually using some kind of biological glue. However, several cases of successful conservative management have been described. In this Editorial, I comment on the metanalysis conducted by Matteucci et al, published in this issue of the Journal, including 11 non-randomized studies and enrolling a total of 363 patients, which brings a great deal of new knowledge that can help not only in the prevention but also in the management of this dreadful complication of AMI.

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Surgical Repair of Postinfarction Ventricular Septal Rupture: Systematic Review and Meta-Analysis

Cited by 62 publications

References 51 publications

Ventricular septal rupture and cardiogenic shock complicating STEMI during COVID-19 pandemic: An old foe re-emerges

Ventricular septal rupture and cardiogenic shock complicating STEMI during COVID-19 pandemic: An old foe re-emerges

Post-Infarction Ventricular Septal Rupture Complicated by Cardiogenic Shock Requiring Mechanical Circulatory Support as a Bridge to Definitive Therapy During the COVID-19 Pandemic

Left ventricular free wall rupture -- a real nightmare

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