Early and late mortality and morbidity after post-MI ventricular septal rupture repair: predictors, strategies, and results.

Abstract

There has been a shift in the paradigm of management of post-myocardial infarction ventricular septal rupture (MI VSR), with many authors reporting improved prognosis if the surgery can be "optimally delayed." Timing of the procedure is of critical importance and our management (UPMS), and prognosis scores (UPPS) have proven to be relevant. However, long-term outcomes and their correlation with our scores had not been analyzed. In this study, we present our long-term results of post-MI-VSR repair and their correlation with our prognosis score (UPPS). Seventy-one patients with post-MI VSR repair (2009-2017) were retrospectively studied. Patients were managed using standard institute protocols. The 30-day mortality was 56% (n = 40). During a mean follow-up of 4.91 ± 2.43years, there were eight late deaths. Actuarial survival of 30-day survivors was 87% at 1year, 74% at 5years, and 69% at 10years. Actuarial freedom from major adverse cardiovascular events (MACE) was 82% at 1year, 72% at 2years, and 72% at 8years. The UPPS score predicts late mortality with sensitivity of 75% and negative predictive value of 84%. Our prognostic score (UPPS) helps not only in predicting early mortality but also in identifying the patients who are likely to live longer. The management score (UPMS) also provides best timing for the procedure, which is helpful in optimal utilization of resources in the developing world. The accuracy of these scores is reasonable and may be helpful in the decision-making in this difficult subset.