Surgical Repair of Ventricular Septal Defect After Myocardial Infarction: Outcomes From The Society of Thoracic Surgeons National Database

Abstract

Background The development of a ventricular septal defect(VSD) after myocardial infarction(MI) is an uncommon but highly lethal complication. We examined the Society of Thoracic Surgeons(STS) database to characterize patients undergoing surgical repair of post-MI VSD and to identify risk factors for poor outcomes. Methods This was a retrospective review of the STS database to identify adult(≥18 years) patients who underwent post-MI VSD repair between 1999–2010. Patients with congenital heart disease were excluded. The primary outcome was operative mortality. The covariates in the current STS model for predicted coronary artery bypass(CABG) operative mortality were incorporated in a logistic regression model in this cohort. Results There were 2,876 patients included. Mean age was 68±11 years, and 1,624(56.5%) were men. 215(7.5%) patients had prior CABG surgery, 950(33%) had prior percutaneous intervention, and 1,869(65.0%) were supported preoperatively with an intra-aortic balloon pump. Surgical status was urgent in 1,007(35.0%) and emergent in 1,430(49.7%). Concomitant CABG was performed in 1,837(63.9%). Operative mortality was 54.1%(1,077/1,990) if repair was ≤7 days from MI, and 18.4%(158/856) if >7 days from MI. Multivariable analysis identified several factors associated with increased odds of operative mortality. Conclusions In the largest study to date to examine post-MI VSD repair, ventricular septal rupture remains a devastating complication. As alternative therapies emerge to treat this condition, these results will serve as a benchmark for future comparisons.

Endovascular treatment of postinfarction ventricular septal defects

“…Смертность среди них составила 54,1% в группе до 7 дней от инфаркта миокарда и 18,4% в группе пациентов, оперированных после этого времени. Чем больше интервал между инфарктом миокар-да и операцией, тем меньше вероятность смерти (менее 6 ч отношение шансов [ОШ] 6,18; 6-24 ч ОШ 5,53; 1-7 дней ОШ 4,59; 8-21 дней ОШ 2,37; p<0,01) [24].…”

Ventricular Septal Rupture After Acute Myocardial Infarction-Do We Know Which Therapeutic Strategy to Choose?

“…Emergent or early surgical intervention remains main definitive treatment for AMI-related VSR. On the other hand as regards classic surgery of VSR, many surgeons recommend the procedure after a 3-4 week delay to allow scarring of the surrounding tissue, which allows firmer anchoring of suture and patch material [6][7][8][9][10]. In case of our second patient the decision of immediate surgical repair of VSR was strictly determined by patient severe state due to cardiogenic shock.…”

“…Fortunately the periprocedural and early recovery outcome was fairly satisfactory. In the meta analysis by Arnaoutakis et al [10] of patients surgically operated due to postinfarction VSR the overall operative mortality was 42.9% (n=1,235). Interestingly, when the procedure was performed within 7 days from AMI, operative mortality was 54.1%, whereas 18.4% when this period was exceeded to more than 7 days from AMI.…”

Post Myocardial Infarction Ventricular Septal Rupture, Early Surgery – Is It Beneficial?

“…4 This repairaims to improve the cardiac output and achieve a hemodynamic stability, still 54% mortality has been reported when surgical repair is attempted within seven days post infarction. 5 Daggett et al reported satisfactory results with their surgical technique and demonstrated reduced mortality and improved cardiac function. 6 Komeda and colleagues suggested surgical repair using the "infarct exclusion method".…”