The enlargement rate of ventricular septal rupture is a risk factor for 30-day mortality in patients with delayed surgery

Abstract

Background: Postinfarction ventricular septal rupture (VSR) is an uncommon but challenging mechanical complication for surgeons. This study analyzed the impacts of rupture size on surgical outcomes in patients with VSR.Methods: During a 15-year period, from January 2006 to December 2020, 112 patients underwent repairs of postinfarction VSR. Patient clinical data, including angiographic and echocardiographic findings, operative procedures, early morbidity and mortality, and survival time were collated. Univariable and multivariable analyses were performed to identify the risk factors of 30-day mortality. Results:The 30-day mortality rate was 7.1% for the whole cohort. The mean survival time estimate was 147.2 months [95% confidence interval (CI): 135.6 to 158.9 months], with a 3-year survival rate of 91.2% and a 5-year survival rate of 89.0%. Multivariable analysis revealed that rupture enlargement rate is an independent risk factor of 30-day mortality. The receiver operating characteristic (ROC) curve indicated that the rupture enlargement rate could predicted the 30-day mortality with high accuracy.Conclusions: Delayed surgery may be considered for patients who respond well to aggressive treatment.The rupture enlargement rate is an independent risk factor for postoperative 30-day morality in patients with delayed VSR repair. Furthermore, the rupture enlargement rate has good predictive value for the prognosis of VSR patients.

Analysis of influencing factors for prognosis of patients with ventricular septal perforation: A single-center retrospective study

“…In this study, the survival rate of patients who underwent repair after 2 weeks of septal perforation was greatly improved, including those who used a mechanical circulatory support to extend the timing of surgery beyond 2 weeks ( P < 0.05). Our study showed that women, worse Killip classification and cardiogenic shock were risk factors for long-term mortality in VSR patients, which is consistent with many existing studies ( 3 , 35 , 36 ). However, due to differences in the study cohort, age did not have a significant effect on survival in patients with VSR in this study.…”

“…The 2013 AHA guidelines for STEMI recommended emergency surgical repair for all patients with VSR, even in hemodynamically stable patients ( 11 ). However, due to an inadequate transportation system in middle-income economies like China, a large proportion of VSR patients cannot receive emergency surgery in a timely manner and therefore, unplanned delayed surgery is common in China ( 3 ).…”

“…Ventricular septal rupture (VSR) is a type of heart rupture. Together with wall rupture and papillary muscle rupture, VSR is a serious and fatal mechanical complication of acute myocardial infarction (AMI), which often occurs within 1–2 weeks after AMI ( 1 – 3 ). This is usually due to the influx of a large number of neutrophils into the necrotic area, which releases enzymes after apoptosis, accelerating the destruction of the infarcted myocardium and resulting in ventricular septal perforation ( 4 ).…”