Predictors of Mortality in Primary Surgical Repair of Postinfarction Ventricular Septal Defects: The Leipzig Experience
Keywords:acute myocardial infarction, cardiogenic shock, coronary artery disease, ventricular septal defect, mechanical complications, cardiac surgery, high risk
Background: A postinfarction ventricular septal defect (pVSD) as a complication of acute myocardial infarction (AMI) is associated with high mortality. This retrospective, single-center study aimed to identify predictors of early and long-term outcomes in patients undergoing primary surgical repair of pVSD managed by various surgical techniques.
Methods: We reviewed data from 77 consecutive patients who underwent primary surgical repair after pVSD in our institution. Prospectively collected demographic and perioperative data were analyzed retrospectively. Predictors of 30-day mortality and long-term outcome were assessed.
Results: pVSD was anterior in 45 patients (58.4%) and posterior in 32 (41.6%). Buttressed mattress suture (n = 9, 11.7%), simple single septal patch (n = 34, 44.2%), simple double septal patch (n = 2, 2.6%), sandwich double patch (n = 1, 1.3%), and the infarct exclusion technique (n = 31, 40.3%) were performed for surgical closure. Fifty-three patients (68.8%) had preoperative cardiogenic shock. The 30-day mortality was 42.8% (33 patients). Independent risk factors of 30-day mortality were duration between AMI and surgery <7 days (odds ratio [OR] 5.229, P = .011), preoperative absence of diuretics (OR 6.913, P = .005), and preoperative cardiogenic shock (OR 3.558, P = .011). Cumulative survival rates at 1, 5, and 10 years were 57.1%, 57.1%, and 31.2%, respectively.
Conclusion: In pVSD, the 30-day mortality remains high, and preoperative cardiogenic shock significantly influenced mortality in our study. None of the surgical techniques or materials used in our investigation influenced the outcome.
Arnaoutakis GJ, Zhao Y, George TJ, Sciortino CM, McCarthy PM, Conte JV. Surgical repair of ventricular septal defect after myocardial infarction: Outcomes from the society of thoracic surgeons national database. Ann Thorac Surg 2012;94:436-443.
Cinq-Mars A, Voisine P, Dagenais F et al. Risk factors of mortality after surgical correction of ventricular septal defect following myocardial infarction: Retrospective analysis and review of the literature. Int J Cardiol 2016;206:27-36.
Cooley DA, Belmonte BA, Zeis L, Schnur S. Surgical repair of ruptured interventricular septum following acute myocardial infarction. Surgery 1957;41:930-937.
Coskun KO, Coskun ST, Popov AF, et al. Experiences with surgical treatment of ventricle septal defect as a post infarction complication. J Cardiothorac Surg 2009;4:3.
Crenshaw BS, Granger CB, Birnbaum Y et al. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. Gusto-i (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) trial investigators. Circulation 2000;101:27-32.
Cummings RG, Reimer KA, Califf R, Hackel D, Boswick J, Lowe JE. Quantitative analysis of right and left ventricular infarction in the presence of postinfarction ventricular septal defect. Circulation 1988;77:33-42.
Daggett WM, Guyton RA, Mundth ED et al. Surgery for post-myocardial infarct ventricular septal defect. Ann Surg 1977;186:260.
David TE, Dale L, Sun Z. Postinfarction ventricular septal rupture: Repair by endocardial patch with infarct exclusion. J Thorac Cardiovasc Surg 1995;110:1315-1322.
Gulkarov IM, Anez-Bustillos L, Wong SC, Salemi A. A hybrid approach in the treatment of post-myocardial infarction ventricular septal defect. Cardiology 2010;116:183-185.
Holzer R, Balzer D, Amin Z et al. Transcatheter closure of postinfarction ventricular septal defects using the new Amplatzer muscular VSD occluder: Results of a U.S. Registry. Catheter Cardiovasc Interv 2004;61:196-201.
Isoda S, Osako M, Kimura T et al. Midterm results of the ‘sandwich technique’ via a right ventricle incision to repair post-infarction ventricular septal defect. Ann Thorac Cardiovasc Surg 2012;18:318-321.
Jorge C, de Oliveira EI, Martins SR, Nobre A, da Silva PC, Diogo AN. Hybrid closure of postinfarction ventricular septal rupture enlargement after transcathether closure with amplatzer occluder. Eur Heart J Acute Cardiovasc Care 2012;1:57-59.
Kim IS, Lee JH, Lee DS et al. Surgical outcomes of a modified infarct exclusion technique for post-infarction ventricular septal defects. Korean J Thorac Cardiovasc Surg 2015;48:381-386.
Lafci B, Yakut N, Goktogan T et al. Repair of post-infarct ventricular septal rupture with an infarct-exclusion technique: Early results. Heart Surg Forum 2006;9:E737-E740.
Lee WY, Cardon L, Slodki SJ. Perforation of infarcted interventricular septum: Report of a case with prolonged survival, diagnosed ante mortem by cardiac catheterization, and review of the literature. Arch Intern Med 1962;109:731-741.
Lock JE, Block PC, McKay RG, Baim DS, Keane JF. Transcatheter closure of ventricular septal defects. Circulation 1988;78:361-368.
Lundblad R, Abdelnoor M. Surgery of postinfarction ventricular septal rupture: The effect of David infarct exclusion versus Daggett direct septal closure on early and late outcomes. J Thorac Cardiovasc Surg 2014;148:2736-2742.
Maltais S, Ibrahim R, Basmadjian AJ, et al. Postinfarction ventricular septal defects: Towards a new treatment algorithm? Ann Thorac Surg 2009;87:687-692.
Moreyra AE, Huang MS, Wilson AC, et al. Trends in incidence and mortality rates of ventricular septal rupture during acute myocardial infarction. Am J Cardiol 2010;106:1095-1100.
Okamoto Y, Yamamoto K, Asami F et al. Early and midterm outcomes of triple patch technique for postinfarction ventricular septal defects. J Thorac Cardiovasc Surg 2016;151:1711-1716.
Pang PY, Sin YK, Lim CH, et al. Outcome and survival analysis of surgical repair of post-infarction ventricular septal rupture. J Cardiothorac Surg 2013;8:44.
Papadopoulos N, Moritz A, Dzemali O et al. Long-term results after surgical repair of postinfarction ventricular septal rupture by infarct exclusion technique. Ann Thorac Surg 2009;87:1421-1425.
Schlotter F, de Waha S, Eitel I, Desch S, Fuernau G, Thiele H. Interventional post-myocardial infarction ventricular septal defect closure: A systematic review of current evidence. EuroIntervention 2016;12:94-102.
Sibal AK, Prasad S, Alison P, Nand P, Haydock D. Acute ischaemic ventricular septal defect—A formidable surgical challenge. Heart Lung Circ 2010;19:71-74.
Statistisches Bundesamt. 2015 Todesursachenstatistik, die 10 häufigsten todesursachen insgesamt. Available at https://www.destatis.de/DE/ZahlenFakten/GesellschaftStaat/Gesundheit/Todesursachen/Tabellen/SterbefaelleInsgesamt.html. (Accessed September 2, 2018.)
Takahashi H, Arif R, Almashhoor A, Ruhparwar A, Karck M, Kallenbach K. Long-term results after surgical treatment of postinfarction ventricular septal rupture. Eur J Cardiothorac Surg 2015;47:720-724.
Thiele H, Kaulfersch C, Daehnert I et al. Immediate primary transcatheter closure of postinfarction ventricular septal defects. Eur Heart J 2009;30:81-88.
Trivedi KR, Aldebert P, Riberi A et al. Sequential management of post-myocardial infarction ventricular septal defects. Arch Cardiovasc Dis 2015;108:321-330.
Vondran M, Wehbe M, Leontyev S, et al. Emergency surgery after unsuccessful immediate primary percutaneous post-infarction ventricular septal defect closure: A single center case series. Thorac Cardiovasc Surg 2016;64(suppl 1):OP80.
Yam N, Au TW-K, Cheng L-C. Post-infarction ventricular septal defect: surgical outcomes in the last decade. Asian Cardiovasc Thorac Ann 2013;21:539-545.
Zhu XY, Qin YW, Han YL et al. Long-term efficacy of transcatheter closure of ventricular septal defect in combination with percutaneous coronary intervention in patients with ventricular septal defect complicating acute myocardial infarction: A multicentre study. EuroIntervention 2013;8:1270-1276.
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