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

Abstract

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.

Systematic review and meta-analysis of the mechanical complications of ischemic heart disease: papillary muscle rupture, left ventricle rupture and post-infarct ventricular septal defect

“…The overall mortality of percutaneous repair of PMI-VSD reported in this study (37.5%) is similar to surgical outcomes of post-infarct VSD from various national registry data, ranging from 33.0-42.9% (70)(71)(72). This is despite a significant proportion of patients treated with primary percutaneous intervention being of prohibitive surgical risk.…”

“…The corrected estimated mortality was higher than reported surgical outcomes This manuscript highlights the increased risk that patients are at when they require early surgery. Acute surgery has been demonstrated to be high-risk for surgical intervention, for both PMI-VSD and PMR (68)(69)(70)(71)(72). Various strategies of prolonging time to surgery have been proposed including, the use of medical support with inotropes and mechanical assist devices, such as intra-aortic balloon pumps and extra-corporeal membrane oxygenation.…”

Tactics of Surgical Treatment of Postinfarction Ventricular Septum Rupture Depending on the Time after the Development of an Acute Myocardial Infarction

“…Останні, як правило, вже завершені у хворих 3-ї групи, навіть з урахуванням індивідуальних особливостей, що пояснює зменшення часу між госпіталізацією та виконанням хірургічного втручання. Отримані результати відповідають даним літератури, які присвячені вивченню клінічних проявів дефекту МШП, а також розвитку порушень гемодинаміки у вигляді бівентрикулярної недостатності у пацієнтів із ПРМШП [9,10,11,12].…”

“…Таким чином, виявлений нами факт відсутності відмінностей у частоті резекції аневризми ЛШ у пацієнтів досліджуваних груп із ПРМШП пов'язаний з індивідуальними особливостями процесів постінфарктного ремоделювання серця та відсутністю колатерального кровообігу міокарда. Зазначені вище статистичні закономірності загалом узгоджуються із загальновідомими уявленнями про перебіг ІХС у пацієнтів із перенесеним ГІМ [11].…”

“…Виявлені нами особливості реваскуляризації міокарда ЛШ відповідають літературним даним, які присвячені вивченню анатомії атеросклеротичного ураження КА [1,9,11].…”