Determinants of in-hospital and long-term surgical outcomes after repair of postinfarction ventricular septal rupture.
OBJECTIVE
Surgical repair of post-myocardial infarction ventricular septal rupture is challenging with reported early mortality being substantial. In addition, congestive cardiac failure and ventricular tachyarrhythmia frequently occur long term after the operation, although frequency and predictive factors of these events have been poorly identified.


METHODS
A consecutive series of 68 patients who underwent repair of postinfarction ventricular septal rupture by 14 surgeons between 1988 and 2007 was studied. Fifty-eight (85%) patients underwent repair in an urgent setting (<48 hours after diagnosis). Coronary artery bypass grafting was concomitantly performed in 48 (71%) patients. Mean follow-up period was 9.2 +/- 4.9 years.


RESULTS
Thirty-day mortality was 35%, with previous myocardial infarction, previous cardiac surgery, preoperative left ventricular ejection fraction less than 40%, and urgent surgery being independent risk factors. Actuarial survival of 30-day survivors was 88% at 5 years, 73% at 10 years, and 51% at 15 years. Actuarial freedom from congestive cardiac failure and ventricular tachyarrhythmia was 70% and 85% at 5 years, 54% and 71% at 10 years, and 28% and 61% at 15 years, respectively. Independent predictors for congestive cardiac failure included hypertension, posterior septal rupture, residual interventricular communication, and preoperative left ventricular ejection fraction less than 40%, whereas concomitant ventricular aneurysmectomy and preoperative occlusion of the left anterior descending artery were independent predictors of ventricular tachyarrhythmia.


CONCLUSIONS
Long-term outcomes after surgical repair of postinfarction ventricular septal rupture was favorable, despite infrequent exposure by individual surgeons to the pathologic features, indicating that an aggressive surgical approach is warranted. Predictors of congestive cardiac failure and ventricular arrhythmia long term varied.
Fukushima
Satsuki
S
Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, QLD 4032, Australia. Satsuki_Fukushima@health.qld.gov.au
Tesar
Peter J
PJ
Jalali
Homayoun
H
Clarke
Andrew J
AJ
Sharma
Hemant
H
Choudhary
Jivesh
J
Bartlett
Harry
H
Pohlner
Peter G
PG
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006333:Heart Failure / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D018658:Ventricular Septal Rupture / Q000401:mortality / Q000601:surgery*