Postinfarction ventricular septal rupture: the Wessex experience.
Surgical repair of a postinfarct ventricular septal defect (VSD) remains a difficult surgical challenge associated with a significant operative mortality. Between 1972 and 1995, 179 patients with a postinfarct VSD have undergone operation in this institution. There were 118 males and 61 females, with a mean age of 66 years (range 43 to 80). Operative mortality was 26.7%. Surgery was deferred until 1 month after the septal rupture in 29 patients, with these labeled as having a chronic VSD. The remaining 150 underwent operation on within 1 month of infarction and are described as having an acute VSD. For those with an acute VSD, factors significantly associated with an increased risk of 30-day mortality included preoperative New York Heart Association status (P = .04), site of myocardial infarction (inferior worse than anterior) (P = .004), cross-clamp time (P = .05) and cardiopulmonary bypass time (P = .0001) (logistic regression). On multiple logistic regression, only cardiopulmonary bypass time remained significant. Survival including in-hospital mortality at 5 and 10 years was 49% +/- 4% and 31% +/- 5% and excluding in-hospital mortality was 72% +/- 5% and 45% +/- 6%, respectively. Those patients who survived attained a good quality of life. No factors were significantly associated with prolonged survival.
Dalrymple-Hay
M J
MJ
Wessex Cardiothoracic Centre, Southampton General Hospital, UK.
Monro
J L
JL
Livesey
S A
SA
Lamb
R K
RK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D002417:Cattle; D001026:Coronary Artery Bypass; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D010496:Pericardium / Q000637:transplantation; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D018658:Ventricular Septal Rupture / Q000401:mortality / Q000601:surgery*