Surgical Repair of Ventricular Septal Defect After Myocardial Infarction: Outcomes From The Society of Thoracic Surgeons National Database

• Published in: The Annals of thoracic surgery Vol. 94; no. 2; pp. 436 - 444
• Main Authors: Arnaoutakis, George J., MD, Zhao, Yue, PhD, George, Timothy J., MD, Sciortino, Christopher M., MD, PhD, McCarthy, Patrick M., MD, Conte, John V., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2012; Elsevier
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Coronary heart disease; Databases, Factual; Female; Heart; Heart Septal Defects, Ventricular - etiology; Heart Septal Defects, Ventricular - surgery; Humans; Male; Medical sciences; Myocardial Infarction - complications; Pneumology; Retrospective Studies; Risk Factors; Surgery; Treatment Outcome; coronary artery disease; ejection fraction; IABP; myocardial infarction; odds ratio; New York Heart Association; SD; percutaneous coronary intervention; STS; Adult Cardiac Surgery Database; cardiopulmonary bypass; Society of Thoracic Surgeons; mitral valve; ventricular septal defect; MI; 30; NYHA; EF; intraaortic balloon pump; OR; CI; VSD; CAD; MV; coronary artery bypass graft; ACSD; ventricular assist device; CPB; PCI; VAD; confidence interval; CABG; standard deviation; Myocardial infarction; Corrective surgery; Prognosis; Ventricular septal defect; Cardiovascular disease; Intracardiac defect; Thorax; Coronary heart disease; Congenital disease; Myocardial disease; Surgeon; Treatment; Malformation; Database; Anesthesia; Circulatory system; Society; Cardiology; Repair
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2012.04.020

Background The development of a ventricular septal defect (VSD) after myocardial infarction (MI) is an uncommon but highly lethal complication. We examined The Society of Thoracic Surgeons database to characterize patients undergoing surgical repair of post-MI VSD and to identify risk factors for poor outcomes. Methods This was a retrospective review of The Society of Thoracic Surgeons database to identify adults (aged ≥18 years) who underwent post-MI VSD repair between 1999 and 2010. Patients with congenital heart disease were excluded. The primary outcome was operative death. The covariates in the current The Society of Thoracic Surgeons model for predicted coronary artery bypass grafting operative death were incorporated in a logistic regression model in this cohort. Results The study included 2,876 patients (1,624 men [56.5%]), who were a mean age of 68 ± 11 years. Of these, 215 (7.5%) had prior coronary artery bypass grafting operations, 950 (33%) had prior percutaneous intervention, and 1,869 (65.0%) were supported preoperatively with an intraaortic balloon pump. Surgical status was urgent in 1,007 (35.0%) and emergencies in 1,430 (49.7%). Concomitant coronary artery bypass grafting was performed in 1,837 (63.9%). Operative mortality was 54.1% (1,077 of 1,990) if repair was within 7 days from MI and 18.4% (158 of 856) if more than 7 days from MI. Multivariable analysis identified several factors associated with increased odds of operative death. Conclusions In the largest study to date to examine post-MI VSD repair, ventricular septal rupture remains a devastating complication. As alternative therapies emerge to treat this condition, these results will serve as a benchmark for future comparisons.