Acute postinfarction septal rupture: Long-term results

Abstract

From 1973 to 1989, 66 patients received early surgical repair for acute postinfarction ventricular septal rupture. Mean age was 64 ± 7 years (range, 45 to 80 years). Ventricular septal rupture occurred soon after acute myocardial infarction (3.4 ± 4 days), and the first medical treatment occurred 6.7 ± 7 days after onset of acute myocardial infarction. Three patients had a previous myocardial infarction. The site of the rupture was anterior in 38 patients (57%) and posterior in 28 (43%). Forty-four patients (67%) were in shock at the time of admission. Intraaortic balloon pumping was used pre-operatively in 28. Operation was performed at the time of maximal efficacy of medical treatment. The same technique was used in all cases. Associated procedures included coronary bypass grafting in 5 patients and valvar operation in 5. The patients have been carefully followed up for up to 16 years. Hospital mortality was 45% (30 patients) and was cardiac related or due to acute renal failure in 25 patients (83%). No correlation could be revealed between early death and age, sex, preoperative intraaortic balloon pumping, or year of operation. Location of the ventricular septal rupture (early mortality of 57% for posterior versus 37% for anterior ventricular septal rupture) and shock at the time of admission (52% versus 32%) showed a trend toward significance (0.08 ≤ p < 0.10). Response to initial active therapy has a strong predictive value (mortality of 70% in unresponsive patients versus 14% in responders; p < 0.001). The actuarial survival rate was 56% ± 6% at 1 year, 44% ± 6% at 5 years (n = 23), and 26% ± 10% at 10 years (n = 10). The cause of late death was cardiac related in 38% of patients. Early surgical repair of early septal rupture after acute myocardial infarction has a high perioperative mortality rate but provides a good quality of life and long-term survival. Improvement should be possible by optimized techniques of myocardial reperfusion and transplantation. The age of the patients and the presence of initial cardiogenic shock make transplantation an infrequent option.