Early mortality after surgical repair of postinfarction ventricular septal rupture: importance of rupture location.
BACKGROUND
The aim of this study was to identify factors influencing early outcome after surgical treatment of postinfarction ventricular septal rupture. We investigated the influence of proximal or distal rupture location.


METHODS
Between 1980 and 1992 109 patients were treated surgically for ventricular septal rupture using a standardized technique. A division in time periods was made. The rupture was categorized according to its anterior or posterior site and proximal or distal location.


RESULTS
The 30-day mortality rate was 27.5%. Multivariate logistic regression analysis identified preoperative shock (p = 0.0007) and right atrial oxygen saturation less than 60% (p = 0.021) as predictors for early death; the risk for early death declined over the time periods from 50% to 12.8% (p = 0.0007). Proximal ventricular septal rupture location (p = 0.0092) and interval between infarction and ventricular septal rupture less then 1 day (p = 0.034) were risk factors for the occurrence of preoperative shock.


CONCLUSIONS
Proximal ventricular septal rupture location was the main determinant of preoperative cardiogenic shock, which in turn was the strongest predictor of early mortality. Over the time periods a decrease in early mortality was reached.
Cox
F F
FF
Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Morshuis
W J
WJ
Plokker
H W
HW
Kelder
J C
JC
van Swieten
H A
HA
Brutel de la Rivière
A
A
Knaepen
P J
PJ
Vermeulen
F E
FE
D000368:Aged; D000369:Aged, 80 and over; D016280:Atrial Function, Right; D001794:Blood Pressure; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000473:pathology / Q000503:physiopathology; D009426:Netherlands / Q000453:epidemiology; D010100:Oxygen / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D018658:Ventricular Septal Rupture / Q000401:mortality / Q000473:pathology / Q000601:surgery*
D010100:Oxygen