Survival and risk factors associated with surgical repair of ventricular septal rupture after acute myocardial infarction: A single-center experience

Abstract

ObjectiveTo analyze the survival and risk factors associated with the surgical treatment of ventricular septal rupture (VSR) after acute myocardial infarction (AMI).MethodsWe retrospectively analyzed 45 consecutive patients with VSR after AMI whose procedures were performed in the Department of Cardiovascular Surgery at the General Hospital of Northern Theater Command between January 2012 and December 2021. Relevant clinical data, surgery-related conditions, and follow-up data of all patients were summarized. Patients were divided into the survival group and the death group. The Kaplan–Meier method and log-rank test were used to determine the cumulative incidence of all-cause mortality. Multivariate logistic regression was used to evaluate the independent risk factors for all-cause mortality.ResultsThe average postoperative follow-up time was 42.1 ± 34.1 months. The overall mortality rate was 20% (9/45 patients) and the operative mortality rate was 8.9% (4/45 patients). Logistic analysis showed that the death group had higher serum creatinine (127.32 ± 47.82 vs. 82.61 ± 27.80 μmol/L, respectively; P = 0.0238) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) [8,654.00 pg/mL (6,197.00–11,949.00 pg/mL) vs. 4,268.96 pg/mL (1,800.00–7,894.00 pg/mL), respectively; P = 0.0134] levels than the survival group. The cardiopulmonary bypass time (CPB) was longer in the death group than in the survival group [131.00 min (121.00–184.00 min) vs. 119.00 min (103.00–151.50 min), respectively; P = 0.0454]. Significantly more red blood cells were transfused in the death group than in the survival group [11.60 units (6.10–16.50) vs. 3.75 units (0.00–7.00 units), respectively; P = 0.0025]. Intra-aortic balloon pump (IABP) implantation (P = 0.016) and ventilation time (P = 0.0022) were risk factors for mortality. A 1-month landmark analysis showed that compared with patients with VSR to surgical time >14 days, patients who underwent surgery within 14 days had a higher rate of all-cause mortality (25.00 vs. 3.33%; log-rank P = 0.023). Patients with VSR within 14 days also had a higher rate of residual shunts that were higher than moderate. Multivariate analysis showed that transfusion of red blood cells and NT-proBNP level were risk factors for all-cause mortality, as well as major adverse cardiovascular and cerebrovascular events.ConclusionsSurgical repair resulted in good outcomes for patients with VSR after AMI. Patients with VSR to surgical time >14 days had a lower rate of all-cause mortality. Treatment strategies for VSR should be based on the patient's condition and comprehensively determined through real-time evaluation and monitoring.

Long-Term Results and Risk Factors of Treatment for Post-Infarction Ventricular Septal Rupture: A Single-Center Experience

“…If a patient arrives at our facility with circulatory system collapse or multi-organ failure, we usu-ally decline surgery. We previously reported that repair could have the best results after rupture beyond 2 weeks [10]. However, in the present study, the transcatheter intervention group demonstrated a longer time (33 [24-37] vs. 21 [14-28] days) after rupture and less IABP use than that in the surgical group (24% vs. 77.78%), indicating that the condition of the patients in the transcatheter intervention group was less severe.…”

“…First, the time for surgical repair after VSR was 21.00 (14.00-28.00) days, i.e., when the infarction tissue was firm to repair. Second, the anterior VSR type was the most common (88.89%, 40/45), which has been associated with better survival [10,12]. Finally, surgery is usually performed in relatively stable patients.…”

“…However, an elder patient with multiorgan failure usually was refused to surgery for poorer prognosis. Surgical details of VSR repair have been reported previously [10]. Concomitant operations included coronary artery bypass grafting (CABG), ventricular aneurysm operation and valve repair or replacement.…”

Extracorporeal Left Ventricular Assist Device as a Bridge to Surgery for Ventricular Septal Rupture After Acute Myocardial Infarction

“…1 Early surgery has been associated with high mortality rates and risk of recurrent ventricular rupture, and although delayed intervention allows for the repair of scar tissue, it includes the risk of rupture extension, cardiogenic shock, and multiple organ dysfunction syndrome (MODS); moreover, the patient may die while awaiting surgery. 2,3 The immediate preoperative hemodynamic status significantly influences postoperative outcomes. 4 Different mechanical circulatory support (MCS) devices, such as intra-aortic balloon pump (IABP), Impella, Tandem Heart, and extracorporeal membrane oxygenation (ECMO), have distinct hemodynamic effects, insertion methods, monitoring requirements, and clinical applicability.…”

“…[5][6][7][8] Advancements in MCS technology significantly improved the success rate in treating cardiogenic shock, and delayed and elective surgical procedures are strategies acknowledged by several researchers. 2,3 Although the concept of perioperative mechanical circulatory support in high-risk patients with VSR and cardiogenic shock has been reported, 9 the use of an extracorporeal left ventricular assist device (extra-VAD) as a bridge to surgical VSR repair and coronary artery bypass grafting has not been described, particularly in China. In this report, we present a case of successful application of an extra-VAD as a bridge to surgical repair in a patient with cardiogenic shock due to VSR after AMI.…”