title: Surgery for post infarction ventricular septal defect (VSD): risk factors for hospital death and long term results.
abstract: OBJECTIVE
  Repair of post infarction ventricular septal defect (VSD) is still a challenging procedure with a high risk of recurrence of the VSD and subsequent mortality. The aim of this retrospective study was to assess if technical change in the surgical procedure was followed by an improvement in recurrence of the VSD and operative results.
  
  
  METHODS
  This retrospective study from 1971 to 2001 included 85 patients operated on early (<15 days) after the occurrence of a post infarction VSD. Double patch technique was introduced in 1986. A total of 44 variables were studied by a uni- and multivariate analysis.
  
  
  RESULTS
  Hospital death occurred in 36 patients. Significant factors for hospital mortality included: preoperative and evolution of the clinical status, right ventricular function and type of repair (one or two patches). Moreover, no recurrence was observed in patients repaired with the double patch technique (P=0.09). None of the studied variables were significant for long term survival. Concomitant CABG was not associated with higher hospital mortality and long-term survival rate was similar in patients with or without concomitant CABG.
  
  
  CONCLUSIONS
  The use of the double patch technique and glue by avoiding recurrence of the VSD played a role in the reduction of the hospital mortality. This technique has to be recommended in the early repair of post infarction VSD. Concomitant CABG can be done safely to control the added risk of an associated coronary artery lesion.
authors.affiliation: Department of Cardio-Vascular Surgery, Hopital Haut-Lévêque, Avenue de Magellan, 33604 Bordeaux-Pessac, France. louis.labrousse@chu-bordeaux.fr
authors.forename: L
authors.initials: L
authors.lastname: Labrousse
authors.forename: E
authors.initials: E
authors.lastname: Choukroun
authors.forename: J M
authors.initials: JM
authors.lastname: Chevalier
authors.forename: F
authors.initials: F
authors.lastname: Madonna
authors.forename: F
authors.initials: F
authors.lastname: Robertie
authors.forename: F
authors.initials: F
authors.lastname: Merlico
authors.forename: P
authors.initials: P
authors.lastname: Coste
authors.forename: C
authors.initials: C
authors.lastname: Deville
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002303:Cardiac Output, Low / Q000209:etiology / Q000401:mortality; D001026:Coronary Artery Bypass; D005260:Female; D005602:France / Q000453:epidemiology; D006345:Heart Septal Defects, Ventricular / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013995:Time; D013997:Time Factors; D016896:Treatment Outcome; D016278:Ventricular Function, Right / Q000502:physiology