title: Risk factors of mortality after surgical correction of ventricular septal defect following myocardial infarction: Retrospective analysis and review of the literature.
abstract: BACKGROUND
  Rupture of the ventricular septum following acute myocardial infarction (AMI) is an uncommon but serious complication, usually leading to congestive heart failure and cardiogenic shock. Surgical repair is the only definitive treatment for this condition.
  
  
  METHODS
  We review our experience of surgical repair of post-infarction ventricular septal defects (VSDs), analyze the associated risk factors and outcomes, and do a complete review of the literature. A retrospective study was performed on 34 consecutive patients who had undergone surgical repair for VSDs following AMI from December 1991 to July 2014. Preoperative, clinical and echocardiographic variables were studied by uni-and multivariate analyses.
  
  
  RESULTS
  Mortality was analyzed for the entire group of patients. Mean age was 69 ± 7 years with 44% women. VSDs were anterior in 11 (32%) and posterior in 23 (68%) patients. A majority, 24 (71%) patients were in cardiogenic shock. Median interval from myocardial infarction to VSDs repair was 7 days. The 30 days operative mortality was 65%. Mortality within the posterior VSDs group was 74% and the anterior VSDs group was 46% (P=0.14). Concomitant coronary artery bypass graft (CABG) did not influence early or late survival. Multivariate analysis identified older age (HR=1.11, P=0.0001) and shorter time between AMI and surgery (HR=0.90, P=0.015) as independent predictors of 30-day and long-term mortality.
  
  
  CONCLUSIONS
  In conclusion, surgical repair of post-AMI VSDs carries a high operative mortality. An algorithm of treatment for the management of these patients is suggested.
authors.affiliation: Research Center, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Cinq-Mars
authors.affiliation: Department of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Voisine
authors.affiliation: Department of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Dagenais
authors.affiliation: Department of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada.
authors.forename: Éric
authors.initials: É
authors.lastname: Charbonneau
authors.affiliation: Department of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Jacques
authors.affiliation: Department of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Kalavrouziotis
authors.affiliation: Department of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Perron
authors.affiliation: Department of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada.
authors.forename: Siamak
authors.initials: S
authors.lastname: Mohammadi
authors.affiliation: Research Center, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Dubois
authors.affiliation: Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada.
authors.forename: Florent
authors.initials: F
authors.lastname: Le Ven
authors.affiliation: Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Poirier
authors.affiliation: Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: O'Connor
authors.affiliation: Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Bernier
authors.affiliation: Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Bergeron
authors.affiliation: Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Canada. Electronic address: mario.senechal@criucpq.ulaval.ca.
authors.forename: Mario
authors.initials: M
authors.lastname: Sénéchal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Myocardial infarction; Outcomes; Risk factors; Ventricular septal defect