Determinants of in-hospital and long-term surgical outcomes after repair of postinfarction ventricular septal rupture

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 140; no. 1; pp. 59 - 65
• Main Authors: Fukushima, Satsuki, MD, PhD, Tesar, Peter J., FRACS, Jalali, Homayoun, FRACS, Clarke, Andrew J., FRACS, Sharma, Hemant, MCh, Choudhary, Jivesh, MCh, Bartlett, Harry, PhD, Pohlner, Peter G., FRACS
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.07.2010; Elsevier
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - mortality; Cardiology. Vascular system; Cardiothoracic Surgery; Chi-Square Distribution; Female; Heart Failure - etiology; Hospital Mortality; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Medical sciences; Middle Aged; Pneumology; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Risk Factors; Tachycardia, Ventricular - etiology; Time Factors; Treatment Outcome; Ventricular Septal Rupture - mortality; Ventricular Septal Rupture - surgery; main adverse coronary event; myocardial infarction; LVEF; left anterior descending coronary artery; LV; LAD; left ventricular ejection fraction; VSR; MACE; ventricular septal rupture; left ventricular; CABG; MI; 30; coronary artery bypass grafting; Corrective surgery; Prognosis; Treatment; Rupture; Anesthesia; Circulatory system; Hospital; Cardiology; Repair; Long term
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2009.09.018

Objectives 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.