title: Percutaneous Closure of Post-Infarction Ventricular Septal Defects-An Over Decade-long Experience.
abstract: OBJECTIVE
  To report an over decade-long experience with percutaneous post-infarction ventricular septal defect (PIVSD) closure.
  
  
  BACKGROUND
  PIVSDs remains a major clinical challenge with extremely high mortality. Data concerning interventional closure of PIVSD is scarce.
  
  
  METHODS
  All percutaneous PIVSD closures performed between 2003 and 2016 in 8 participating centres were identified. Data concerning patients and procedures was acquired. Patients were divided into two groups, based on the time interval between VSD diagnosis and closure (≤14 days-acute phase, >14 days-non-acute phase).
  
  
  RESULTS
  Twenty-one percutaneous PIVSD closures were performed on 20 patients (9 females, mean age: 70 years). Mean interval between the diagnosis and the procedure was 182.6 ± 500 days (range: 7-2228). Defects were mostly located in apical (55%) segments of the septum. In 7 cases (33%) the procedure was performed in the acute phase. The closure was technically successful in 17 cases (81%). Four patients died within 48 hours after the procedure. 30-days survival rate of the entire cohort was 70%. Univariate analysis revealed impact of technical success of the procedure (HR 0.13, CI 0.03-0.68 P = 0.016) and white blood cell count (HR 1.36 per unit increase, CI 1.1-1.69, P = 0.005) on 30-day mortality.
  
  
  CONCLUSIONS
  In a selected population of patients percutaneous PIVSD closure is feasible and provides satisfactory survival rate. Procedural success has a protective impact on survival. Timing of the closure remains controversial. Procedure in the non-acute phase carries lower mortality, but at the same time introduces a selection bias. Larger registry-based studies are required.
authors.affiliation: Department of Pediatric Cardiology and Congenital Heart Disease, Medical University of Gdańsk, Gdańsk, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Sabiniewicz
authors.affiliation: First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Zenon
authors.initials: Z
authors.lastname: Huczek
authors.affiliation: First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Karol
authors.initials: K
authors.lastname: Zbroński
authors.affiliation: First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Scisło
authors.affiliation: First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Rymuza
authors.affiliation: First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Kochman
authors.affiliation: Department of Cardiology with Subunit for Acute Coronary Syndromes, Clinical Hospital no. 2, Rzeszów, Poland.
authors.forename: Miłosz
authors.initials: M
authors.lastname: Marć
authors.affiliation: First Department of Cardiology, Medical University of Poznań, Poznań, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Grygier
authors.affiliation: First Department of Cardiology, Medical University of Poznań, Poznań, Poland.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Araszkiewicz
authors.affiliation: Central Laboratory of Endovascular Diagnostics of Cardiovascular Diseases, Clinical Hospital, Poznań, Poland.
authors.forename: Mieczysław
authors.initials: M
authors.lastname: Dziarmaga
authors.affiliation: Department of Cardiology and Invasive Cardiology, Public Hospital, Szczecin, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Leśniewicz
authors.affiliation: Department of Cardiology, Public Hospital, Nowa Sól, Poland.
authors.forename: Jarosław
authors.initials: J
authors.lastname: Hiczkiewicz
authors.affiliation: Department of Cardiology, Medical University of Łódź, Łódź, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Kidawa
authors.affiliation: First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Krzysztof J
authors.initials: KJ
authors.lastname: Filipiak
authors.affiliation: First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Opolski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D015331:Cohort Studies; 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 / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D016896:Treatment Outcome