Postinfarction Ventricular Septal Defect Research Articles

Extended use of axillary impella 5.5 as a bridge to post-infarct ventricular septal defect repair.

Post-infarct ventricular septal defect (VSD) carries high mortality. Since emergent repair of post-infarct VSD is challenging, hemodynamic stabilization utilizing temporary mechanical circulatory support crucially provides time to delay intervention and allows necessary scar tissue formation which improves the fragility of myocardium and leads to a definitive repair. To date, there remains no standard for achieving hemodynamic stability, including usage and mode of temporary mechanical circulatory support. We describe a patient with acute post-infarct VSD in cardiogenic shock successfully supported with Impella 5.5 for 67days as a bridge to surgical repair and coronary artery bypass grafting.

Persistent Fistula Closure After Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography by Postinfarct Ventricular Septal Defect Occluder

Persistent Fistula Closure After Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography by Postinfarct Ventricular Septal Defect Occluder

Surgical closure versus transcatheter closure for ventricular septal defect post-infarction: a meta-analysis.

Surgical correction of post-infarct ventricular septal defect (PIVSD) is associated with a significant incidence of morbidity and mortality. The authors aimed to evaluate the effectiveness and safety of surgical versus transcatheter approaches in the management of PIVSD. A systematic review and meta-analysis of retrospective from five databases including the Cochrane Library, PubMed, Web of Science, Ovid, and Scopus) until 9 March 2024 was conducted. Risk ratio (RR) for dichotomous outcomes was used and data with a 95% CI are presented. A total of 7 retrospective observational studies with 603 patients were included in the analysis. Surgical closure was associated with a significantly lower short-term mortality and lower number of residual shunt or re-intervention rate compared to percutaneous closure, with a relative risk (RR) of 1.21 (95% CI:1:00-1.46, P = 0.05) and 2.68 (95% CI: 1.46-4.91, P = 0.001), respectively. Surgical closure was associated with a non-significantly lower long-term mortality rate compared to percutaneous closure, with a relative risk (RR) of 1.10 (95% CI: 0.82-1.48, P = 0.52). No difference is reported when time from acute myocardial infarction (AMI) or PIVSD to intervention is compared groups, with a relative risk (RR) of -0.24 (95% CI: -4.49 to 4.2, P = 0.91). Our meta-analysis shied the light on the significance of surgical closure in terms of short-term mortality and the need for re-intervention. However, no significant difference was observed in terms of long-term mortality and time to intervention.

Transcatheter Closure of Postinfarct VSD With the Amplatzer PIVSD Occluder: Results of a US Study

BackgroundA postinfarct ventricular septal defect (PIVSD) is associated with high mortality and morbidity, particularly in patients with hemodynamic instability who are not suitable candidates for surgical repair. The Amplatzer PIVSD Occluder (Abbott) is indicated for transcatheter PIVSD closure in patients who are not satisfactory candidates for surgical repair. The objective of this study was to evaluate associated clinical outcomes. MethodsA total of 131 patients underwent transcatheter PIVSD closure using the Amplatzer PIVSD Occluder between 2011 and 2021 as part of a postapproval, multicenter, retrospective, observational study. The patients were analyzed in 2 cohorts. Cohort 1 included 99 patients (age 68.6 ± 11.9 years) implanted from 2011 to 2016 and evaluated technical success, procedure survival, and 6-month survival. Cohort 2 included 32 patients (age 66.4 ± 10.9 years) implanted from 2012 to 2021 with postprocedure echocardiograms and evaluated 24-hour closure, 6-month closure, and 6-month survival. ResultsTechnical success was achieved in 76.8% (76/99), procedure survival in 84.3% (75/89), and 6-month survival was observed in 37.2% of cohort 1 patients. Twenty-four-hour closure and 6-month closure were achieved in 53.1% (17/32) and 66.7% (4/6) of cohort 2 patients, respectively. Six-month survival was 46.4% of cohort 2 patients. Of the 16 deaths in cohort 2, 11 were cardiac-related, 4 were noncardiac-related, and 1 was of unknown etiology. ConclusionsThis study demonstrates high morbidity of patients undergoing PIVSD closure using the Amplatzer PIVSD Occluder and that the device continues to be a safe alternative to medical therapy in patients who are not satisfactory candidates for surgical repair of a PIVSD.

Post-infarction ventricular septal defect associated with coronary ectasia. Case report

Post-infarction ventricular septal defect associated with coronary ectasia. Case report

Systematic Review and Meta‐Analysis of Comparative Studies: Transcatheter Versus Surgical Closure for Postinfarct Ventricular Septal Defect

Background: Postinfarct ventricular septal defect (PIVSD) is a serious complication of acute myocardial infarction (AMI). Transcatheter closure is a potential alternative to surgical closure for PIVSD patients.Objective: This meta‐analysis compares the clinical outcomes of transcatheter closure versus surgical closure for PIVSD.Methods: A systemic search of PubMed and Embase until January 2023 identified studies comparing transcatheter versus surgical PIVSD closure. Primary outcomes included short‐term mortality. Short‐term mortality referred to the number of in‐hospital or 30‐day deaths. Secondary outcomes comprised residual shunt/reintervention incidence, difference in time from AMI or PIVSD diagnosis to intervention, the presence of cardiogenic shock, incidence of perioperative mechanical support, PIVSD size difference, and overall mortality at follow‐up.Results: Seven studies comprising 603 patients were included. Short‐term mortality (OR, 1.30; 95% CI [0.90, 1.89]; p = 0.17; I2 = 3.0%) did not significantly differ between the two groups. The incidence of residual shunt/reintervention (OR, 3.56; CI, 1.33–9.59; p = 0.01; I2 = 63.0%) and PIVSD size (mean difference, −3.94 mm; CI [−6.90, −0.99]; p = 0.09; I2 = 83.0%) were significantly different; however, the other secondary outcomes were not significantly different.Conclusion: Transcatheter and surgical closure demonstrate similar short‐term mortality. Despite a higher incidence of residual shunt or reintervention in transcatheter closure, it may be a viable option in patients with small size of PIVSD.

Post-Infarction Ventricular Septal Defect: A quarter century experience.

Post-infarction ventricular septal defect (VSD) is one of the known complications after acute myocardial infarction. This study investigated the clinical results after surgical repair of VSD. This retrospective study included all patients undergoing surgical repair of VSD from 1996 to 2020 in Oman. Out of a total of 75 patients, 62.5% were men, with a mean age of 59 years. The mean follow-up was 17.2 (7.5) years. Of the 75 patients, 34 (45.3%) patients died within 30 days. Total survival was 41.3% at 5 years, while the 10-year survival rate was 33.3%. Outcomes and predictors for 30 days mortality were the number of concomitant coronary involvement and anastomoses performed, residual postoperative shunt and postoperative dialysis. Even with surgical repair, early mortality of post-infarction septal defect is still considerably high. Early repair and the anatomically posterior rupture are predictors of early mortality. In patients surviving the immediate postoperative period, long-term survival is limited by pre-existing coronary artery disease, postoperative renal failure and the presence of a residual postoperative shunt.

Surgical repair of post myocardial infarction ventricular septal defect: a retrospective analysis of a single institution experience

IntroductionVentricular septal defect (VSD) is a mechanical complication of acute myocardial infarction (MI) with a very high mortality, despite advances in surgical and circulatory support. The tremendous hemodynamic disturbance and the severely fragile myocardium render surgical repair a great challenge. The optimal time of surgical repair with or without circulatory support is still controversial.ObjectiveThe aim of this study is to review our experience with early surgical repair of post-MI VSD in a single major cardiac institution in China.MethodsFrom January 2013 to October 2020, 9consecutive patients presented to our emergency department with a diagnosis of post-MI VSD. Among them, 8 were male, and the mean age was 58 ± 7years. The mean VSD size was 22.5 ± 5.7 mm. In all patients, an intra-aortic balloon pump (IABP)was inserted immediately after admission to cardiac surgery service. All patients were operated at a mean of 3.3 ± 2.9 days, and 4 within 24 h of the rupture (range 1 to 9 days post-VSD). In 5 cases, the VSD was located superiorly, and 4 cases in the posterior septum.ResultsThe overall 30-day mortality was 11% (1/9). Coronary angiography was performed in all nine patients, four with single vessel disease had coronary stents implanted, and the other five received concomitant coronary artery bypass grafting during VSD repair surgery. There was no death in all 5 patients with anterior septal perforation. One patient with posterior septal perforation died in the operating room due to bleeding from the ventriculotomy site. Three survived patients were diagnosed with a small residual defect and mild left to right shunt post-repair. However, no further intervention was required, and patients remained asymptomatic (Killip II in 1 and III in 2).ConclusionIn our experience, immediate insertion of IABP and hemodynamic stabilization with early surgical intervention of VSD repair and concomitant coronary revascularization provided an 89% survival rate.

Addressing "immortal time bias" in the evaluation of treatment outcomes for post-infarction ventricular septal defect: implications for clinical practice and research

Abstract Introduction Post-infarction ventricular septal defect (VSD) is a rare but life-threatening complication of acute myocardial infarction (AMI). Surgical closure (SC) has traditionally been the standard treatment, but in recent years, percutaneous transcatheter (PC) closure has emerged as an alternative. This study aims to investigate the potential for "immortal time bias" in treatment selection for post-infarction VSD. Methods 8,022 patients who presented with STEMI, of whom 80 (1%) had a VSD. Among these: 26 SC, 20 underwent PC, and 34 received medical management (MM). The primary endpoint was in-hospital mortality. We used the Kaplan–Meier curves (Fig 1C) to plot survival, and to address immortal time bias, we used the time to closure as a time-dependent covariate and conducted a landmark analysis using time-dependent Cox proportional hazard regression. Significance was set at P≤0.05. Results The baseline and admission characteristics in the 3 groups are summarized in Table 1. The mean age was 64.4 years, and most were men (78.8%) with comorbidities such as DM(48.8%) and HTN(57.5%). At presentation, patients managed with MM were more likely to have high-risk features, including lower systolic blood pressure, LVEF; and higher right ventricular dysfunction. 21 patients (26.3%) presented with cardiogenic shock, which was more common in the MM group (SC 11.5%, PC 10%, vs MM 47.1%; P=0.001). The delay between the onset of AMI-arrival was similar in the SC and PC groups (P=0.95) but longer compared to MM (6 vs 5 vs 0.8 days, respectively, P<0.001). Patients managed with MM had a shorter time from onset of STEMI-VSD diagnosis (4 [2-9] SC, 4 [2-20] PC, and 2 [1-4] days for MM; P=0.03). The time from onset of STEMI-closure was 22 (12-45) days, with no significant difference in closure achievers (P=0.78) (Fig 1A). Only 19 patients (23.8%) received reperfusion therapy, most receiving thrombolytic treatment, and only 8 receiving pPCI. Inotropics, vasopressors, and invasive ventilation were used more frequently in the MM group. To evaluate the potential for survival bias, logistic regression was performed with the closure of VSD versus the time of AMI-event (closure or death) as the outcome variable for the entire cohort. The analysis showed a time-dependent gradient of reaching closure (P<0.001) with OR=1.15 (1.08-1.23) per day since AMI. This finding was corroborated by a spline that showed linearity df=1 X2=13.2 P<0.001. In the time-dependent analysis of the cohort, there were no significant differences in mortality (P=0.331) with a HR=1.69 (0.75-3.81; P=0.204) for SC and 0.78 (0.33-1.87; P=0.578) for PC vs MM (Fig1C). Conclusion Results showed a time-dependent gradient of reaching VSD closure, and a time-varying analysis showed no differences in mortality between SC or PC compared to MM. The findings of this study suggest that future studies evaluating outcomes for post-infarction VSD should take into account the potential for immortal time bias.Table 1Figure 1

Analysis of immortal-time effect in post-infarction ventricular septal defect.

Time-fixed analyses have traditionally been utilized to examine outcomes in post-infarction ventricular septal defect (VSD). The aims of this study were to: (1) analyze the relationship between VSD closure/non-closure and mortality; (2) assess the presence of immortal-time bias. In this retrospective cohort study, patients with ST-elevation myocardial infarction (STEMI) complicated by VSD. Time-fixed and time-dependent Cox regression methodologies were employed. The study included 80 patients: surgical closure (n = 26), transcatheter closure (n = 20), or conservative management alone (n = 34). At presentation, patients without VSD closure exhibited high-risk clinical characteristics, had the shortest median time intervals from STEMI onset to VSD development (4.0, 4.0, and 2.0 days, respectively; P = 0.03) and from STEMI symptom onset to hospital arrival (6.0, 5.0, and 0.8 days, respectively; P < 0.0001). The median time from STEMI onset to closure was 22.0 days (P = 0.14). In-hospital mortality rate was higher among patients who did not undergo defect closure (50%, 35%, and 88.2%, respectively; P < 0.0001). Closure of the defect using a fixed-time method was associated with lower in-hospital mortality (HR = 0.13, 95% CI 0.05-0.31, P < 0.0001, and HR 0.13, 95% CI 0.04-0.36, P < 0.0001, for surgery and transcatheter closure, respectively). However, when employing a time-varying method, this association was not observed (HR = 0.95, 95% CI 0.45-1.98, P = 0.90, and HR 0.88, 95% CI 0.41-1.87, P = 0.74, for surgery and transcatheter closure, respectively). These findings suggest the presence of an immortal-time bias. This study highlights that using a fixed-time analytic approach in post-infarction VSD can result in immortal-time bias. Researchers should consider employing time-dependent methodologies.

Hybrid Closure of Postinfarction Apical Ventricular Septal Defect Using Septal Occluder Device and Right Ventricular Free Wall: The Apical BASSINET Concept.

Postinfarction ventricular septal defect (VSD) is a catastrophic complication of myocardial infarction. Surgical repair still has poor outcomes. This report describes clinical outcomes after a novel hybrid transcatheter/surgical repair in patients with apical VSD. Seven patients with postmyocardial infarction apical VSD underwent hybrid transcatheter repair via subxiphoid surgical access. A transcatheter occluder (Amplatzer Septal Occluder) with a trailing premounted suture was deployed through the right ventricular wall and through the ventricular septum into the left ventricular apex. The trailing suture was used to connect an anchor external to the right ventricular wall. Tension on the suture then collapses the right ventricular free wall against the septum and left ventricular occluder, thereby obliterating the VSD. Outcomes were compared with 9 patients who underwent surgical repair using either patch or primary suture closure. All patients had significant left-to-right shunt (Qp:Qs 2.5:1; interquartile range [IQR, 2.1-2.6] hybrid repair versus 2.0:1 [IQR, 2.0-2.5] surgical repair), and elevated right ventricular systolic pressure (62 [IQR, 46-71] versus 49 [IQR, 43-54] mm Hg, respectively). All had severely depressed stroke volume index (22 versus 21 mL/m2) with ≈45% in each group requiring mechanical support preprocedurally. The procedure was done 15 (IQR, 10-50) versus 24 (IQR, 10-134) days postmyocardial infarction, respectively. Both groups of patients underwent repair with technical success and without intraprocedural death. One patient in the hybrid group and 4 in the surgical group developed multiorgan failure. The hybrid group had a higher survival at discharge (86% versus 56%) and at 30 days (71% versus 56%), but similar at 1 year (57% versus 56%). During follow-up, 1 patient in each group required reintervention for residual VSD (hybrid: 9 months versus surgical: 5 days). Early intervention with a hybrid transcatheter/surgical repair may be a viable alternative to traditional surgery for postinfarction apical VSD.

Percutaneous Transcatheter Closure of Post-infarction Ventricular Septal Defect: An Alternative to Surgical Intervention.

Post-infarction ventricular septal defect is a mechanical complication of acute MI. The incidence of this complication is low in the primary percutaneous coronary intervention era. However, the associated mortality is very high at 94% with medical management alone. Open surgical repair or percutaneous transcatheter closure still has an in-hospital mortality >40%. Retrospective comparisons between both closure methods are limited by observation and selection bias. This review addresses the assessment and optimisation of patients prior to repair, the optimal timing of repair, and the limitations in current data. The review considers techniques for percutaneous closure, and finally considers the path that future research should take to improve outcomes for patients.

P290 EXTRACORPOREAL MEMBRANE OXYGENATION SYSTEM AS A BRIDGE TO REPARATIVE SURGERY IN VENTRICULAR SEPTAL DEFECT COMPLICATING ACUTE MYOCARDIAL INFARCTION

Abstract Introduction Post–infarct ventricular septal defect (VSD) is a life tethering complication of acute myocardial infarction which is associated to high in–hospital mortality (90–95%). The optimal peri–operative management including timing of surgical correction is still debated. There is a large body of evidence demonstrating that surgical repair is also associated to poor post–operative outcomes due to cardiogenic shock and multiorgan failure (MOF). The use of extracorporeal membrane oxygenation (ECMO) system in adult cardiac surgery is not routine, occurring in a minority of critically ill patients, typically postoperatively. Here we present our single centre experience of patients with post–infarct VSD managed preoperatively with ECMO support as a bridge to definitive surgical closure. Materials and methods Between February 2020 to July 2021, 5 patients presented to our unit with diagnosis of post–infarct VSD and were managed with preoperative veno–arterial (V–A) ECMO implantation and enrolled in our study. Clinical parameters (such as mean arterial pressure, central venous pressure, ECG, pulmonary artery pressure), blood tests, trans–thoracic and trans–esophageal echocardiography, chest X–rays have been evaluated both before and after surgery. Primary end–point was all causes in–hospital mortality. Results Three (60%) patients were male and mean age was 70,4 (60–78) years. All patients underwent surgical repair. ECMO was positioned between 1 and 9 days prior to surgical correction, giving the chance to reduce the pharmacological inotropic support while still reverting the MOF as demonstrated by the reduction of AST, ALT, bilirubin level, decreased CVP and systemic lactate levels. Two (40%) patients were successfully weaned off from the mechanical support and discharged home in good clinical conditions. Two (40%) patients developed MOF after surgery leading to the exitus. Conclusions We postulate that the use of V–A use preoperatively in patients with cardiogenic shock secondary to post–infarct VSD is appropriate and where feasible should be considered. It allows restoration of haemodynamic stability and resolution of MOF. This provides for a delayed surgical repair with a likely higher chance of operative success and reduced mortality.

Post-infarction ventricular septal defect surgery in Portugal

Introduction and ObjectiveWe performed a collective analysis of a dedicated national post-myocardial infarction ventricular septal defect (VSD) registry to further elucidate controversial areas of this clinical entity's surgical treatment. MethodsA descriptive statistical analysis was carried out and cumulative survival using the Kaplan-Meier method and multivariate logistic regression of risk factors for 30-day mortality are presented. ResultsMedian survival of the cohort (n=76) was 72 months (95% CI 4–144 months). Better cumulative survival was observed in patients who underwent VSD closure more than 10 days after myocardial infarction (log-rank p=0.036). Concomitant coronary artery bypass grafting (CABG), different closure techniques, location of the VSD, extracorporeal membrane oxygenation as bridge to closure, or intra-aortic balloon pump as bridge to closure showed no statistically significant differences at Kaplan-Meier analysis. Multivariate binary logistic regression for independent factors affecting status at 30 days showed a statistically significant effect of age (OR 1.08; 95% CI 1.01–1.15) and concomitant CABG (OR 0.23; 95% CI 0.06–0.90). ConclusionsOur results are comparable with previous reports regarding mortality, risk factors and concomitant procedures. Timing of surgery remains a controversial issue. Later closure seems to be advantageous, however, there is significant observational bias.

Transcatheter closure of large postinfarct ventricular septal defect: Initial results of prototype Occlutech® device including the first-in-human.

Postinfarct ventricular septal rupture is a serious complication in delayed or failed reperfusion with a grim prognosis. The optimal timing and treatment option remain debatable in the absence of randomized controlled trials. Percutaneous device closure is a well-reported and less invasive treatment option but recent imaging studies indicate that majority of defects are too large to be adequately covered by the currently Conformite Europeenne and Food and Drug Administration approved occluder devices. Six patients presented with large and complex postinfarct ventricular septal ruptures, considered unsuitable for the Amplatzer post-infarct ventricular septal defect Occluder, sowere treated using the prototype Occlutech® 36 mm PI-VSD occluder, including the first-in-human use. The prototype device was successfully deployed in all patients with satisfactory immediate results and shunt reduction. Three patients (50%) in cardiogenic shock did not survive beyond discharge, of which two were complicated by device dislodgement or embolization. Percutaneous closure of large postinfarct ventricular septal ruptures is possible using newer device with a wider coverage. Further device refinement is necessary to improve treatment outcomes.

Assessment of post-infarct ventricular septal defects through 3D printing and statistical shape analysis.

Post-infarct ventricular septal defect (PIVSD) is a serious complication of myocardial infarction. We evaluated 3D-printing models in PIVSD clinical assessment and the feasibility of statistical shape modeling for morphological analysis of the defects. Models (n=15) reconstructed from computed tomography data were evaluated by clinicians (n=8). Statistical shape modeling was performed on 3D meshes to calculate the mean morphological configuration of the defects. Clinicians' evaluation highlighted the models' utility in displaying defects for interventional/surgical planning, education/training and device development. However, models lack dynamic representation. Morphological analysis was feasible and revealed oval-shaped (n=12) and complex channel-like (n=3) defects. 3D-PIVSD models can complement imaging data for teaching and procedural planning. Statistical shape modeling is feasible in this scenario.

Endovascular repair as a rescue strategy to restoring the extracorporeal membrane oxygenation flow

Ventricular septal defect (VSD) is a known complication after myocardial infarction associated with high mortality. Extracorporeal membrane oxygenation (ECMO) is being successfully used in patients with VSD as a bridge to definitive surgical repair. Although often the only possibility to stabilize hemodynamics and oxygenation, ECMO has many potential complications, carrying significant morbidity and mortality. Here, the patient presented with a postinfarct VSD on peripheral venoarterial ECMO who developed a dissection of the common iliac artery (CIA) on the 5th day after ECMO implantation. As a result, a sudden drop in ECMO flow has become evident along with high pressures in the arterial cannula. After a definitive diagnosis of a CIA lesion obstructing the blood flow was made, trans-ECMO endovascular repair of CIA was performed. Four days after endovascular repair, we encountered the same problem of decreased blood flow associated with stent kinking and were approached with another endovascular repair to re-establishing full ECMO flow.

Impella Support for Surgical Ventricular Septal Defect Repair.

Acute postinfarct ventricular septal defect (VSD) is associated with high mortality due to a combination of cardiogenic shock and a complex repair in recently infarcted fragile myocardium. 1 Although the Impella heart pump is established as support for cardiogenic shock, it is relatively contraindicated in postinfarct VSD because of potential right-to-left shunt or stroke due to VSD tissue-related embolus. On autopsy, early repair is technically difficult due to tissue friability and as a result, 38% of surgically repaired patients have evidence of recurrent interventricular septal rupture. 2 Delayed surgical repair (>7 days) is associated with superior survival-54% after 7 days versus 18% prior-but hemodynamic instability may prevent delay. 3 Case reports have shown successful early left ventricular unloading with Impella patients with acute postinfarct VSD before surgical repair. 4,5 We discuss our algorithm for pre-repair Impella support in which we stratify pre-repair support based on the Qp/Qs ratio. For VSD with Qp/Qs >2.5, we use a preoperative Impella heart pump and have not demonstrated reversal in the left-to-right shunt on echocardiography and/or stroke. Our findings are consistent with theoretical models of unloading as demonstrated by shifts in pressure-volume loops. 6.

Single arterial access closure of post-infarction ventricular septal defect: A case series.

Post-infarction ventricular septal defect (PIVSD) carries a very poor prognosis. Surgical repair offers reasonable outcomes in patients who survive the initial healing period. Percutaneous device implantation remains a potentially effective earlier alternative. From March 2018 to May 2022, 11 trans-arterial PIVSD closures were attempted in 9 patients from twocenters (aged 67.2 ± 11.1 years; 77.8% male). Two patients had a second procedure. Myocardial infarction was anterior in four patients (44.5%) and inferior in five cases (55.5%). Devices were successfully implanted in all patients. There were no major immediate procedural complications. Immediate shunt grade postprocedure was significant (11.1%), minimal (77.8%), or none (11.1%). Median length of stay after the procedure was 14.8 days. Five patients (55%) survived to discharge and were followed up for a median of 605 days, during which time no additional patients died. Single arterial access for percutaneous closure of PIVSD is a good option for these extremely high-risk patients, in the era of effective large-bore arterial access closure. Mortality remains high, but patients who survive to discharge do well in the longer term.

Post-infarction ventricular septal defect: percutaneous or surgical management in the UK national registry.

Post-infarction ventricular septal defect (PIVSD) is a mechanical complication of acute myocardial infarction (AMI) with a poor prognosis. Surgical repair is the mainstay of treatment, although percutaneous closure is increasingly undertaken. Patients treated with surgical or percutaneous repair of PIVSD (2010-2021) were identified at 16 UK centres. Case note review was undertaken. The primary outcome was long-term mortality. Patient groups were allocated based upon initial management (percutaneous or surgical). Three-hundred sixty-two patients received 416 procedures (131 percutaneous, 231 surgery). 16.1% of percutaneous patients subsequently had surgery. 7.8% of surgical patients subsequently had percutaneous treatment. Times from AMI to treatment were similar [percutaneous 9 (6-14) vs. surgical 9 (4-22) days, P = 0.18]. Surgical patients were more likely to have cardiogenic shock (62.8% vs. 51.9%, P = 0.044). Percutaneous patients were substantially older [72 (64-77) vs. 67 (61-73) years, P < 0.001] and more likely to be discussed in a heart team setting. There was no difference in long-term mortality between patients (61.1% vs. 53.7%, P = 0.17). In-hospital mortality was lower in the surgical group (55.0% vs. 44.2%, P = 0.048) with no difference in mortality after hospital discharge (P = 0.65). Cardiogenic shock [adjusted hazard ratio (aHR) 1.97 (95% confidence interval 1.37-2.84), P < 0.001), percutaneous approach [aHR 1.44 (1.01-2.05), P = 0.042], and number of vessels with coronary artery disease [aHR 1.22 (1.01-1.47), P = 0.043] were independently associated with long-term mortality. Surgical and percutaneous repair are viable options for management of PIVSD. There was no difference in post-discharge long-term mortality between patients, although in-hospital mortality was lower for surgery.