Surgical Repair of Post-Infarction Ventricular Septal Defect　― Findings From a Japanese National Database ―

Abstract

base (ACSD) to examine risk factors for outcomes after surgical repair of post-MI VSD. 9 In Japan, the Japan Adult Cardiovascular Surgery Database (JCVSD) was established in 2000. 10 Thus, in the present study, we report a Japanese multicenter experience of surgical repair of post-MI VSD using the JCVSD. Methods Data Collection The JCVSD includes 255 variables that are nearly identical to those in the database of the STS. Informed consent to register clinical data in the JCVSD was obtained from each patient. The JCVSD Organization Review Board approved the present study. From the JCVSD, we identified adults (age ≥18 years) undergoing surgical repair of a post-MI VSD from January 2008 to December 2014. Eligible patients were identified by an affirmative response in the JCVSD data field for MI. Patients who underwent concomitant procedures such as coronary revascularization or valvular surgeries were V entricular septal defect (VSD) is a rare but lethal complication of acute myocardial infarction (MI). 1 For patients treated medically, the mortality of post-MI VSD exceeds 90%. 2 With the development of acute reperfusion strategies for MI, the incidence of post-MI VSD occurs in less than 1% of patients sustaining MI. 1,2 Despite significant improvements over the past 2 decades in overall mortality for patients with acute MI, the outcome of patients who develop post-MI VSD remains poor. Even for patients who are treated surgically, mortality has been high, ranging between 19% and 60% in patients. 1-7 However, most of these reports involved single-center experience with small sample sizes. To improve the outcomes, further study from a larger multicenter experience may be necessary. Recently, several studies with large sample sizes from national databases have been reported from Europe and the USA. A single national registry report from Sweden reported 189 patients treated during a 7-year span. 8 National registry data have been provided by the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Data

Emergency sandwich patch repair via right ventricular incision for postinfarction ventricular septal defects: a case series

“…This was comparable to that of elective VSD repair reported in the Japanese National Database study (15.6% in elective surgery vs. 40.6% in emergency surgery; P < 0.01). 3 …”

“…Furthermore, ventricular suture-line bleeding in the infarct left ventricle is a serious complication associated with hospital mortality. 3 In contrast, ventricular suture-line bleeding following the RV incision is not a common finding even in the acute phase of AMI, because the ischaemic damage to the RV myocardium is unlikely to occur as the oxygen demand is significantly lower in the right ventricle than in the left ventricle, the coronary perfusion in the right ventricle is obtained from the RV branch during both systole and diastole, and extensive collateral flows from the left coronary to the RV branch exist. 9 , 10 …”

Mortality and risk factors after a surgical repair of postinfarction ventricular septal defect

“…Although many surgeons do not revascularize the culprit vessel, other coronary lesions are often grafted at the time of VSD repair. Moreover, Malhotra et al (13), proposed that if a patient with anterior VSD has a well-visualized fi rst septal with left main disease or proximal signifi cant disease of the left anterior descending artery (LAD), CABG with graft to the proximal LAD should be performed.…”

Current indication and practical management of percutaneous left ventricular assist device support therapy in Japan

“…A literature review showed that urgent or early surgery for VSP is associated with high mortality rate (30-60 %) [19,20], whereas delayed surgery in patients who respond to aggressive medical therapy seems to be have better outcome, minimizing the mortality rate to about 15 % [19,21]. The first case of Impella for VSP was reported in Italy in 2009, which suggested a reduction in left-to-right shunt and right ventricular overload in addition to increasing cardiac output [10,22].…”