Surgical treatment of postinfarction ventricular septal defect: risk factors and outcome analysis

Pojar, Marek; Harrer, Jan; Omran, Nedal; Turek, Z.; Striteska, Jana; Vojacek, Jan

doi:10.1093/icvts/ivx230

Cited by 21 publications

(18 citation statements)

References 15 publications

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“…Similarly to previous reports, we found that patients undergoing surgery temporarily closer to the index MI were more likely to die 7,10–12 . Immediately after the MI, tissues are more friable, and this makes the operation more technically demanding.…”

Section: Discussionsupporting

confidence: 86%

Surgical outcomes of post‐infarct ventricular septal defect repair: Insights from the UK national adult cardiac surgery audit database

Dimagli

Guida

Sinha

et al. 2021

Journal of Cardiac Surgery

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Objectives Ventricular septal defect (VSD) is becoming a progressively less frequent mechanical complication of myocardial infarction (MI). However, this event is still associated with high operative mortality. We aimed to describe the trends and the risk factors associated with surgical VSD repair outcomes and to provide a clinical benchmark for percutaneous VSD closure strategies. Methods Using the UK National Adult Cardiac Surgery Audit database, we identified 1010 patients undergoing surgical VSD repair from 1996 to 2018. The primary outcome was operative mortality. Mixed‐model, multivariable logistic regression was used to identify the risk factors associated with operative mortality taking into account the variation related to the centre, the surgeon and the year of the operation. Results Both the number of surgical VSD repair and the mortality rate did not change significantly over the 23‐year timeframe. Operative mortality was 38.9% overall and was higher when patients were operated within the first 6 h (75%) or the first 24 h (61.3%) from the index MI. Risk factors associated with higher odds of mortality were early surgery, older age, cardiogenic shock, renal failure, previous percutaneous coronary intervention and urgent/emergent operations. Moreover, the mortality rate was similar among patients undergoing isolated VSD repair and VSD repaired combined with surgical coronary revascularization alone or with concomitant mitral valve procedures. Conclusions Post MI VSD remains a dreaded mechanical complication characterized by high surgical operative mortality. A delayed operation, whenever possible, appears to be the most beneficial strategy to reduce mortality.

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Section: Discussionsupporting

confidence: 86%

Surgical outcomes of post‐infarct ventricular septal defect repair: Insights from the UK national adult cardiac surgery audit database

Dimagli

Guida

Sinha

et al. 2021

Journal of Cardiac Surgery

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show abstract

“…. The data obtained are consistent with the literature report on the high risk of death in patients with post-MI VSD during surgery at the early stages after the development of acute MI, against the hemodynamic instability and comorbidity [8,13,14,15], and CKD as an early mortality risk factor [16].…”

Section: Resultssupporting

confidence: 91%

Analysis of Predictors of 30-Day Mortality for Patients Undergoing Surgical Repair of Post-Myocardial Infarction Ventricular Septal Defect

Lebedieva

Chacón-Lozsán

Aliyev³

et al. 2021

JPRI

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Aims: Despite the existence of numerous studies devoted to predictors of 30-day mortality in patients with post-myocardial infarction (MI) ventricular septum defect (VSD), the choice of surgical treatment tactics for post-MI VSD remains an item of discussion. The purpose of the research was to determine the most significant risk factors of 30-day mortality in patients with post-MI VSD in order to optimize the tactics of such patients’ surgical repair. Study design: The retrospective analysis of the results of a comprehensive examination and surgical treatment of 88 in-patients with post-MI VSD for the period of 2002-2019 was carried out. Results: As follows of the research findings, independent predictors of 30-day mortality in patients with post-MI VSD were determined. The predictors identified were combined into a Scoring system to stratify the risk of surgical failure in patients with post-MI VSD. Modelling the surgery outcomes makes it possible to optimize the tactics of surgical treatment of patients with post-MI VSD. Conclusion: we have identified the most significant predictors of 30-day mortality in patients with post-MI VSD. The Score designed for mortality risk assessment is easy in use compared to other existing tools used in clinical practices when planning the surgical intervention in post-MI VSD patients. This Score may allow the stratification of post-MI VSD patients.

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“…A significant limitation to this study is that we were unable to separate concomitant CABG procedures by bypassed territory. Surgeons in the concomitant CABG are separated into two camps: those who argue any stenotic vessels that are not supplying infarcted tissue should be grafted 17 and those who argue grafting to infarcted vessels is beneficial in reperfusing the ischemic border and preventing ventricular arrhythmias 18 . Since we cannot separate these data, it is not possible to say which technique is superior.…”

Section: Discussionmentioning

confidence: 99%

“…those who argue any stenotic vessels that are not supplying infarcted tissue should be grafted 17 and those who argue grafting to infarcted vessels is beneficial in reperfusing the ischemic border and preventing ventricular arrhythmias. 18 Since we cannot separate these data, it is not possible to say which technique is superior. Given a mean follow up of 2.06 years, it is also possible that the benefits of CABG have not been significantly demonstrated in this cohort as most benefits to CABG are seen following a 24 month period.…”

Section: Limitations and Future Directionsmentioning

confidence: 99%

Repair of ischemic ventricular septal defect with and without coronary artery bypass grafting

et al. 2020

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Background and Aim of the Study: Ventricular septal defect (VSD) following myocardial infarction (MI) is a relatively infrequent complication with high mortality.We sought to investigate the effect of concomitant coronary artery bypass graft (CABG) on outcomes following post-MI VSD repair.Methods: Electronic search was performed to identify all relevant studies published from 2000 to 2018. Sixty-seven studies were selected for the analysis comprising 2174 patients with post-MI VSD. Demographic information, perioperative variables, and outcomes including survival data were extracted and pooled for systematic review and meta-analysis.Results: Single-vessel disease was most common (47%, 95% confidence interval [CI], 42-52), left anterior descending coronary artery was the most commonly involved vessel (55%, 95% CI, 46-63), and anterior wall was the most commonly affected territory (57%, 95% CI, 51-63). Concomitant CABG was performed in 52% (95% CI, 46-57) of patients. Of these, infarcted territory was re-vascularized in 54% (95% CI, 23-82). A residual/recurrent shunt was present in 29% (95% CI, 24-34) of patients.Of these, surgical repair was performed in 35% (95% CI, 28-41) and transcatheter repair in 11% (95% CI, 6-21). Thirty-day mortality was 30% (95% CI, 26-35) in patients who had preoperative coronary angiogram, and 58% (95% CI, 43-71) in those who did not (P < .01). No significant survival difference observed between those who had concomitant CABG vs those without CABG.Conclusions: Concomitant CABG did not have a significant effect on survival following VSD repair. Revascularization should be weighed against the risks associated with prolonged cardiopulmonary bypass. K E Y W O R D S concomitant coronary artery bypass graft, myocardial infarction, transcatheter closure, ventricular septal defect

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Surgical treatment of postinfarction ventricular septal defect: risk factors and outcome analysis

Abstract: Surgical repair of postinfarction ventricular septal defect has a high 30-day mortality rate. Higher age at presentation and postoperative renal replacement therapy are independent predictors of early mortality.

Cited by 21 publications

References 15 publications

Surgical outcomes of post‐infarct ventricular septal defect repair: Insights from the UK national adult cardiac surgery audit database

Surgical outcomes of post‐infarct ventricular septal defect repair: Insights from the UK national adult cardiac surgery audit database

Analysis of Predictors of 30-Day Mortality for Patients Undergoing Surgical Repair of Post-Myocardial Infarction Ventricular Septal Defect

Repair of ischemic ventricular septal defect with and without coronary artery bypass grafting

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