title: Long-term results after surgical repair of postinfarction ventricular septal rupture by infarct exclusion technique.
abstract: 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.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Hospital, Frankfurt/Main, Germany. nestoras.papadopoulos@gmail.com
authors.forename: Nestoras
authors.initials: N
authors.lastname: Papadopoulos
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
authors.forename: Omer
authors.initials: O
authors.lastname: Dzemali
authors.forename: Andreas
authors.initials: A
authors.lastname: Zierer
authors.forename: Amin
authors.initials: A
authors.lastname: Rouhollapour
authors.forename: Hanns
authors.initials: H
authors.lastname: Ackermann
authors.forename: Farhad
authors.initials: F
authors.lastname: Bakhtiary
mesh_terms: 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*