Postinfarct ventricular septal defect repair: effect of coronary artery bypass grafting.
Between June 1968 and April 1991, 75 patients who had undergone coronary angiography underwent repair of a postinfarction ventricular septal defect. Group 1 (n = 33) includes patients who had two- or three-vessel serious (> 75% narrowing) proximal coronary artery disease and underwent complete revascularization in addition to repair of the ventricular septal defect. Group 2 (n = 19) patients also had two- or three-vessel coronary artery disease but bypass grafting was not performed; only the ventricular defect was repaired. Group 3 (n = 23) patients had only single-vessel coronary artery disease that corresponded to the region of the infarct; they underwent ventricular septal defect repair only. Follow-up of hospital survivors was 96% complete at a mean of 86.2 months (range, 1 to 288 months). Hospital mortality after ventricular septal defect repair was 21.2% in the cohort with bypassed coronary artery disease (group 1), 26.3% in those with unbypassed disease (group 2), and 26.1% in those with only single-vessel coronary artery disease (group 3) (p = 0.88). With follow-up after 5 and 10 years, the actuarial survival was 72.2% +/- 8% and 47.8% +/- 10%, respectively, in the bypassed group, 29.2% +/- 11% and 0%, respectively, in the unbypassed group, and 52.2% +/- 10% and 36.5% +/- 11%, respectively, in the cohort with single-vessel disease. Bypassing associated coronary artery disease significantly increased long-term survival when compared with patients with unbypassed coronary artery disease (p = 0.0015).
Muehrcke
D D
DD
Surgical Cardiovascular Unit, Massachusetts General Hospital, Harvard Medical School, Boston 02114.
Daggett
W M
WM
Buckley
M J
MJ
Akins
C W
CW
Hilgenberg
A D
AD
Austen
W G
WG
D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality; D003327:Coronary Disease / Q000473:pathology / Q000601:surgery; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000401:mortality / Q000601:surgery*; D006346:Heart Septum; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate