RISK FACTORS OF MORTALITY AFTER SURGICAL CORRECTION OF VENTRICULAR SEPTAL DEFECT FOLLOWING MYOCARDIAL INFARCTION

Abstract

Rupture of the ventricular septum following myocardial infarction (MI) is an uncommon but serious complication, usually leading to congestive heart failure and cardiogenic shock. Surgical repair is the only definitive treatment for this condition but is associated with a high operative mortality. This study sought to analyze the associated risk factors and outcomes in this population. A retrospective review was performed on 34 consecutive patients who had undergone surgical repair of ventricular septal defect (VSD) following MI from December 1991 to June 2013. Preoperative, clinical and echocardiographic variables were analysis. Mean age was 69±5 years and 44% were females. The VSD was anterior in 11 (32%) and posterior in 23 (68%) patients. Twenty-four (71%) patients were in cardiogenic shock. Mean aortic cross clamp time was 94 minutes and mean cardiopulmonary bypass time was 141 minutes. Median interval from MI to VSD repair was 7 days. Overall operative mortality within 30 days was 65%. Mortality within the posterior VSD group was 74% and the anterior VSD group was 46% (p=0.1) Concomitant CABG did not influence early or late survival. Multivariate analysis identified age and time between MI and operation as independent predictors of 30-day and long-term mortality. Surgical repair of post-infarction VSD carries a high operative mortality. Age and time between MI and operation are independent predictors of 30-days and long-term mortality. In presence of such high-expected postoperative mortality with conventional surgery, alternative therapy may need to be considered (percutaneous VSD closure and heart transplant) especially in patients with posterior VSD.