Repair Of Postinfarction Ventricular Septal Defect Research Articles

Abstract 11235: Timing of Repair in Post-Infarction Ventricular Septal Defect

Background: Post-infarction ventricular septal defect (PIVSD) formation is a rare but devastating complication of ST-elevation myocardial infarction (STEMI). Objective: To determine the association of the timing of VSD repair on in-hospital mortality in patients with PIVSD. Methods: This retrospective cohort study identified 10,902 patients with VSD and STEMI from the Nationwide Readmissions Database from 2003-2018. VSD repair was identified by appropriate ICD9 and ICD10 codes. Patients were stratified based on intervention timing: 0-7 days, 8-14 days, and > 14 days after admission. The primary outcome was in-hospital mortality. Outcomes of patients who received VSD repair were compared patients who did not receive VSD repair within the same time-point. Multivariate logistic regressions were used to adjust for demographic, comorbid, and socioeconomic factors. Analysis was stratified by clinical presentation of cardiogenic shock. Results: In patients in shock, there was a significant decrease in in-hospital mortality with VSD repair at 0-7 days (50.8% vs. 60.4%; OR 0.76; 95% CI 0.68-0.86, p<0.001) as compared to at risk patients who did not undergo VSD repair (Table 1). There was no difference in in-hospital mortality in patients receiving VSD repair at 8-14 days or at > 14 days as compared to who did not undergo VSD repair. In patients not in shock, there was an increase in in-hospital mortality in patients who received VSD repair from 0-7 days (23.8% vs 36%; OR 1.59; 95% CI 1.33-1.90; p<0.001) at compared to those who did not receive VSD repair. There was no significant difference in outcomes in patients not in shock who received VSD repair at 8-14 days or at >14 days as compared to those at who did not receive VSD repair at this timepoint. Conclusions: Early PIVSD repair was associated with a significantly decreased rate of in-hospital mortality in patients in shock, but was associated with significantly higher rate of in-hospital mortality in patients not in shock

Alternative method of patch implantation and creation for postinfarction ventricular septal defect repair by the infarct exclusion technique

Alternative method of patch implantation and creation for postinfarction ventricular septal defect repair by the infarct exclusion technique

Post-infarction ventricular septal defect: surgical outcomes in the last decade

Post-infarction ventricular septal defects require surgical closure. Only a few studies have been conducted in Asian populations. This study reports the current outcomes and determinants affecting survival. Between January 1995 and January 2012, 40 patients underwent surgery for post-infarction ventricular septal defect. We analyzed demographics, clinical, angiographic, and echocardiographic parameters, operative data, postoperative morbidity, and survival. Mean follow-up was 5.2 ± 5.3 years. Univariate and multivariate analyses were used to determine the factors affecting 30-day mortality and long-term survival. There was no intraoperative death. Our 30-day mortality was 20%. Single-vessel disease was found on coronary angiography in 63% of patients. Eight patients had concomitant coronary artery bypass grafting. Overall survival at 1, 5, and 10 years was 68%, 55%, and 42%, respectively. Event-free survival from subsequent angina, myocardial infarction, congestive heart failure, or percutaneous interventions at 1, 5, and 10 years was 66%, 43%, and 25%, respectively. Preoperative oliguria and postoperative sepsis were independent predictors of 30-days mortality on multivariate analysis (p = 0.02). Preoperative left ventricular function was associated with long-term survival (p = 0.048). We had good results of current postinfarction ventricular septal defect repair. Selected patients had concomitant coronary artery bypass grafting. Preoperative oliguria and postoperative sepsis were independent predictors of 30-day mortality, while left ventricular function was related to long-term survival.

Management and midterm outcomes of post-infarction ventricular septal defect

We assessed midterm outcomes, predictors of mortality, and residual defects after repair of post-infarction ventricular septal defect in 10 patients (mean age, 65.3 years; range, 50-78 years) who were operated on between 2000 and 2008. Mean time from onset of symptoms of myocardial infarction to diagnosis of ventricular septal defect was 3.5 days. Time from diagnosis to surgery ranged from 6 h to 84 days. The defects were located anteriorly in 4 patients and posteriorly in 6. Patch reconstruction of the septum was used in 6 patients and the infarct exclusion technique in 4. Hospital mortality was 60%. The only predictor of mortality was tricuspid valve competence (p = 0.048). There was no correlation between location of the defect or type of repair and operative mortality. Residual or recurrent ventricular septal defect was noted in 6 patients. Location of the defect and type of repair were not predictors of residual or recurrent defects. Residual ventricular septal defect was not associated with increased short-term mortality or reduction of functional status. Early mortality associated with post-infarction ventricular septal defect repair is significant. Discharged patients continue to have good functional capacity and quality of life, as well as favorable midterm survival.

Pleuroperitoneal Shunting for Intractable Cardiogenic Pleural Effusions

A 72-year-old man underwent post-infarction ventricular septal defect repair. Postoperatively, he required prolonged ventilation and could not be weaned from positive-pressure-assisted ventilation because of intractable bilateral pleural effusions. Conservative therapy was ineffective. After instituting pleuroperitoneal shunting, the patient could be weaned easily from a respirator.

Double Patch Repair Through a Single Ventriculotomy for Ischemic Ventricular Septal Defects

We present a novel postinfarction ventricular septal defect repair, through a single ventriculotomy, using a biseptal double patch and gelatin-resorcinol-formaldehyde glue. This technique reduces the postoperative recurrence of ventricular septal defects by reducing the tension on the patch sutures and by preventing blood from infiltrating into the suture lines within the ventricular septal defect cavity.

Invited Commentary

Invited Commentary

Surgical repair of postinfarction ventricular septal defect by infarct exclusion.

Repair of postinfarction ventricular septal defect (VSD) by infarct exclusion has been used for a decade in our unit. It involves securing a glutaraldehyde-preserved bovine pericardial patch to the endocardium of the left ventricle all around the necrotic myocardium to exclude the VSD and the infarct from the left ventricular cavity. Fifty-two patients with postinfarction VSD underwent this type of repair from 1987 to 1996. Thirty-four patients were in shock when undergoing operation; 26 had anterior VSD and 26 had posterior. Ten patients died perioperatively, for surgical mortality of 19%. Three patients developed recurrent VSD; one died and two survived. Preoperative cardiogenic shock and age older than 70 years were associated with an increased operative mortality. Operative survivors were followed up from 6 to 135 months, mean of 65 months. The actuarial survival at 8 years was 59% +/- 6%. Repair of postinfarction VSD by infarct exclusion is a relatively simple operative procedure and seems to have improved the results of surgery in patients with posterior VSD.

Postinfarction ventricular septal defect repair: Retrospective thoughts and historical perspectives

Evolution of surgical techniques for repair of postinfarction ventricular septal rupture initially involved differentiation of these lesions from prior experience with surgical approaches to congenital ventricular septal defects, which were in the main not applicable. Second, understanding of the differing anatomical locations of postinfarction ventricular septal defects required innovation in terms of the location of the cardiotomy and type of repair necessary to achieve a successful result in any given patient. The gradual appreciation of different clinical courses pursued by patients after postinfarction ventricular septal rupture both in terms of location of the defect and the degree of right ventricular functional impairment has led to increased urgency relative to the timing of surgical repair. The incorporation of specific anatomical concepts of surgical repair and better understanding of the time course of physiological deterioration of patients can ultimately lead to an integrated approach aimed toward improved salvage of patients suffering this catastrophic complication of acute myocardial infarction.