322: Surgical versus transcatheter closure for post-infarctus ventricular septal defect

Abstract

Post infarction ventricular septal defect (PIVSD) is a difficult to treat condition. Surgical closure is the first intention therapy but mortality rates remain high at 20-87% in current series. Transcatheter closure is a promising alternative although comparative studies are scarce. We describe our experience in 3 centers where surgery and transcatheter closure are available. Between April 2006 and April 2012, 18 consecutive patients with PIVSD were initially treated surgically (n=10, group 1) or percutaneously (n=8, group 2). Three patients received both treatments. Thirteen patients (72%) were admitted 12 hours or more after the onset of acute myocardial infarction (AMI) and 13 were in cardiogenic shock, with intra-aortic balloon pumpin 10 (55%) cases. Twelve (67%) had emergency percutaneous coronary intervention. Themedian delay between AMI and intervention was18,5 (3 to 828) days without difference between the 2 groups. Twelve patients (67%) underwent successful closure of their PIVSD without difference between surgical and percutaneous closure. A residual PIVSD was present in 12 cases, necessitating reintervention in 3 cases (17%). The overall mortality rate was 28% (5/18), including 3 (37,5%) cases after transcatheter and 2 (20%) after surgical closure (p NS). However, early (<20 days after AMI onset) percutaneous treatment was significantly associated with intra-hospital mortality (p=0,01). Surgery remains the first intention therapyfor PIVSD when closure is performed within 20 days after AMI onset. Later, transcatheter closure provides similar results and can be considered as an interesting alternative.