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

Abstract

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

Effects of concomitant coronary artery bypass grafting on early and late mortality in the treatment of post-infarction mechanical complications: a systematic review and meta-analysis

“…This meta-analysis shows that cCABG in surgery for post-AMI mechanical complications can be performed safely without significantly increasing early and late mortality, similarly to what Horan et al recently reported for VSR patients only (7). However, it should be noted that our analysis didn't consider percutaneous revascularization, that was carried out in 956 patients and is usually reported to improve survival (4,5).…”

“…Cardiac rupture usually occurs in single-vessel disease (more frequently LAD) and during the first ischemic episode (24,31,39,47). In the current study, 54.3% of patients had single-vessel CAD (4,7,31). The role of lacking collateral circulation in its pathogenesis may also explain why 83.8% of PMR patients had posteromedial muscle rupture, being it more sensitive to ischemia, because it's usually supplied by terminal branches (58).…”

“…The value of cCABG during surgery for post-infarction mechanical complications remains a matter of debate. Despite representing a treatment for the underlying cause of cardiac rupture, the effects of surgical revascularization on early and late mortality have not been clarified yet (7,35).…”

“…For instance, the advantage of revascularizing necrotic myocardium during high-risk, emergency procedures, remains controversial. Most importantly, there are still conflicting data on whether concomitant CABG (cCABG) provides early and late survival benefit in these patients (7). Thus, we performed a systematic review and meta-analysis of the available literature in order to evaluate the potential survival benefit of cCABG in patients treated surgically for post-AMI mechanical complications.…”

Surgical management for mechanical complications of acute myocardial infarction: a systematic review of long-term outcomes

“…Overall, however, the majority of studies identified demonstrated no long-term survival benefit with concomitant CABG (25,26,28,33,48). This coincides with the findings of a recent systematic review on repair of postinfarction VSD with and without CABG, namely, that concomitant CABG did not have a significant effect on survival (49).…”