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Abstract
BackgroundVentricular septal rupture (VSR) is an uncommon but well-recognized mechanical complication of acute myocardial infarction (AMI). The outcome of VSR remains poor even in the era of reperfusion therapy. We reviewed our experience with surgical repair of post-infarction VSR and analyzed outcomes in an attempt to identify prognostic factors.MethodsFrom October 1995 to December 2013, data from 47 consecutive patients (mean age, 68 ± 9.5 years) with post-infarction VSR who underwent surgical repair at our institute were retrospectively reviewed. The preoperative conditions, morbidity and surgical mortality were analyzed. Multivariate analysis was subsequently carried out by constructing a logistic regression model in order to identify independent predictors of postoperative mortality. Long term survival function were estimated using the Kaplan-Meier method and compared using the log-rank test.ResultsPercutaneous coronary intervention was performed in 17 (36.2%) patients, intra-aortic balloon pump (IABP) was used in 34 (72.3%), and six (12.8%) were supported with extracorporeal membrane oxygenation (ECMO) preoperatively. Forty-one (87.2%) patients received emergent surgical treatment. Concomitant coronary artery bypass grafting was performed in 27 (57.4%) patients.Operative mortality was 36.2% (17 of 47). The survival rate was 59.3% with concomitant CABG and 70% without concomitant CABG (p = 14). Multivariate analysis revealed that the survivors had higher preoperative left ventricular ejection fractions (LVEFs) compared with those who died (51 ± 13.7% vs. 36.6 ± 6.4% , respectively; p < 0.001) and lower European system for cardiac operative risk evaluation II (EuroSCORE II) (22.9 ± 14.9 vs. 38.3 ± 13.9, respectively; p < 0.001). The patients receiving total revascularization has long term survival benefit (p = 0.028).ConclusionsPost-infarction VSR remains a serious and challenging complication of AMI in the modern surgical era. The EuroSCORE II can be used for an approximate prediction of operative mortality. Preserved LVEF was associated with better prognosis, while the need for postoperative RRT was associated with higher early and late mortality. Besides, the strategy of total revascularization should be applied to ensure long-term survival benefit.
Highlights
Ventricular septal rupture (VSR) is an uncommon but well-recognized mechanical complication of acute myocardial infarction (AMI)
We reviewed our experience of post-infarction VSR and analyzed the surgical outcomes in an attempt to identify risk factors associated with mortality
The observed incidence of VSR complicating AMI was 0.98%, which was lower than the incidence quoted from pre-thrombolytic era studies, but slightly higher than the incidence (0.2 ~ 0.4%) reported in the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO-I) trial of more than 41,000 patients treated for myocardial infarction in the thrombolytic era [2]
Summary
Ventricular septal rupture (VSR) is an uncommon but well-recognized mechanical complication of acute myocardial infarction (AMI). The outcome of VSR remains poor even in the era of reperfusion therapy. We reviewed our experience with surgical repair of post-infarction VSR and analyzed outcomes in an attempt to identify prognostic factors. Ventricular septal rupture (VSR) is a fatal complication following acute myocardial infarction (AMI). The incidence of VSR complicating AMI was 1-3% in the era prior to widespread reperfusion therapy [1]. Treatment of VSR after AMI is a surgical challenge and the surgical mortality rate of post-infarction VSR remains high. We reviewed our experience of post-infarction VSR and analyzed the surgical outcomes in an attempt to identify risk factors associated with mortality
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