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

Abstract

Background: Improvements in revascularisation, including pharmacological, catheter-based and surgical, have resulted in improved outcomes for patients with acute myocardial infarction (AMI), leading to decreased frequency of mechanical complications. Improvements in both techniques and technology have permitted select patients to be managed with a purely percutaneous, transcatheter strategy. Through systematic review, this study aims to synthesise the collective experience of percutaneous treatment of the mechanical complications of ischaemic heart disease. Methods: The search strategy queried the electronic databases PubMed, Embase and the Cochrane Central Register of Controlled Trials, from 1 January 2000 to 31 December 2020. Studies highlighting the outcomes of patients receiving percutaneous treatment of post-myocardial infarction papillary muscle rupture (PMR), ventricular septal defect (VSD), left ventricular free wall rupture (FWR) and pseudoaneurysm (PA) were included. A qualitative review of studies was conducted for PMR, FWR and PA. A quantitative analysis was conducted for VSD.Results: Fifteen studies were included in the qualitative synthesis of the percutaneous management of PMR, 4 were included in the qualitative analysis of the percutaneous management of left ventricular FWR, 7 studies defined the outcomes of the percutaneous management of PA and 25 were included in the quantitative meta-analysis of the primary percutaneous management of post-MI VSD. For VSD, there were 43 failed procedures in 314 patients. The proportion of failed procedures was 15.9% and there were 174 deaths in 428 patients. 37.5% of patients experienced early mortality.Conclusions: Although surgical techniques remain the gold standard, we have shown that percutaneous management may be a viable option in certain cases.

Analysis of immortal-time effect in post-infarction ventricular septal defect

“…Conversely, patients who underwent VSD closure demonstrated better survival rates, likely because of their improved clinical and hemodynamic stability and the partial healing of the myocardium post-infarction. In this context, Flynn et al ( 21 ) conducted a meta-analysis of 25 studies of post-AMI VSD, highlighting the most significant risks of bias in confounding, selection bias, and selection of reported outcomes.…”

Association between ischemic heart disease and dietary intake of lycopene: a case–control study

“…The most common complications of IHD include acute mitral regurgitation (MR) secondary to papillary muscle rupture (PMR), ventricular septal defect (VSD), pseudoaneurysm, and free wall rupture (FWR). Each of these complications are related to increased risk of morbidity, mortality, and length of hospitalization ( 3 , 4 ).…”

Ventricular Septal Defect Complicating Myocardial Infarction: A Case of Delayed Percutaneous Transcatheter Closure

“…Post-AMI VSD is a rare complication of AMI, with various clinical manifestations, including hemodynamic instability, cardiac dysfunction and cardiogenic shock. Its incidence is about 0.17%-0.34% [1] , but the inhospital mortality can reach 41-80% [2] .…”