Long-term results after surgical repair of postinfarction ventricular septal rupture by infarct exclusion technique.
BACKGROUND
Ventricular septal defect (VSD) is one of the most serious and life-threatening complications of acute myocardial infarction. The aim of this study was to evaluate the early and long-term results of the patients after surgical repair of postinfarction VSD by infarct exclusion technique.


METHODS
A total of 32 consecutive patients (mean age, 62.5 +/- 10.5 years) underwent postinfarction VSD repair using a standardized technique in our department. A retrospective analysis of clinical and operative data, predictors of early mortality, and long-term survival was performed. The localization of VSD was posterior in 50% and anterior in 50% of the patients.


RESULTS
The hospital mortality was 31.2% (10 patients). The most common cause of hospital death was persistent low cardiac output. The mortality of the posterior VSD group was significantly lower than that of the anterior VSD group (18.7% and 43.7%, respectively, p = 0.01). Intra-aortic balloon pump support and absence of cardiac shock were significantly associated with a lower risk of hospital mortality (p = 0.0001 and p = 0.0009, respectively). The actuarial survival rates of in-hospital survivors at 5 and 10 years were 79% +/- 2% and 51% +/- 3%, respectively.


CONCLUSIONS
The repair of postinfarction VSD by the infarct exclusion is feasible and safe. This technique seems to offer sufficient favorable early and long-term results compared with other techniques. Early indication, preoperative intra-aortic balloon pump support may improve the surgical results. Preoperative cardiogenic shock carries a poor prognosis for this patient group.
Papadopoulos
Nestoras
N
Department of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Hospital, Frankfurt/Main, Germany. nestoras.papadopoulos@gmail.com
Moritz
Anton
A
Dzemali
Omer
O
Zierer
Andreas
A
Rouhollapour
Amin
A
Ackermann
Hanns
H
Bakhtiary
Farhad
F
D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D004452:Echocardiography; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000401:mortality / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D018658:Ventricular Septal Rupture / Q000209:etiology / Q000401:mortality / Q000601:surgery*