Surgery for post infarction ventricular septal defect (VSD): risk factors for hospital death and long term results1

Abstract

The use of the double patch technique and glue by avoiding recurrence of the VSD played a role in the reduction of the hospital mortality. This technique has to be recommended in the early repair of post infarction VSD. Concomitant CABG can be done safely to control the added risk of an associated coronary artery lesion.

Postinfarction Ventricular Septal Rupture – A Rare Complication Remains Challenge for Cardiac Surgical Team

“…This of course is reflected in operative mortality. The 30-day mortality reported by David in 1995 was 19%, Deja in 2000 reported 35%, and Labrousse in 2002 reported 42% in hospital mortality (David et al, 1995;Deja et al, 2000;Labrousse et al, 2002). The overall incidence of early mortality in our series was 40%.…”

“…In 2002 Labrousse and colleagues published a series of 101 consecutive patients with post infarction VSD who were operated on between December 1971 and December 2000. Nineteen percent of them presented with cardiogenic shock, defined as a systolic pressure below 70 mm Hg with evidence of COPD -chronic obstructive pulmonary disease; ECMO -extracorporeal membrane oxygenation; IABK - intraaortic balloon pump; CABG - coronary artery bypass graft; MI - myocardial infarction; PIVSR - post infarction ventricular septal rupture; IABP -intraaortic balloon pump inadequate organ and peripheral perfusion; additional 33% had low cardiac output and severe congestive heart failure (Labrousse et al, 2002). In our series, there were 18 patients (72%) who needed inotropic support before operation due to heart failure, and 13 of them (52%) were in cardiogenic shock.…”

“…In order to improve the surgical results we suggest concentrating all patients with PIVSR in specialized cardiac centers with the access to ventricular assist device. Hemodynamically stable patients should be operated on soon (Deville et al, 1991;David et al, 1995;Labrousse et al, 2002). All patients with acute heart failure or in cardiogenic shock we propose to implant a biventricular assist device and operate on them after improvement of organ dysfunction and hemodynamic stabilization.…”

“…Medical treatment of PIVSR is usually not efficient (Crenshaw et al, 2000), and early surgical closure of the rupture is recommended (Deja et al, 2000;Labrousse et al, 2002;Yip et al, 2004). However surgical repair is associated with a high rate of mortality even in more recent reports (David et al, 1995;Deja et al, 2000;Labrousse et al, 2002).…”

“…However surgical repair is associated with a high rate of mortality even in more recent reports (David et al, 1995;Deja et al, 2000;Labrousse et al, 2002). The most important predictor of operative mortality is preoperative hemodynamic instability.…”