Clinical and surgical profile of patients operated for postinfarction interventricular septal rupture

• Published in: Revista brasileira de cirurgia cardiovascular : orgao oficial da Sociedade Brasileira de Cirurgia Cardiovascular Vol. 25; no. 3; p. 341
• Main Authors: Sá, Michel Pompeu Barros de Oliveira, Sá, Marcus Villander Barros de Oliveira, Barbosa, Caio Henrique, Silva, Niedjon Peixoto de Carvalho, Escobar, Rodrigo Renda de, Rueda, Fábio Gonçalves de, Silva, Frederico Pires Vasconcelos, Lima, Ricardo de Carvalho
• Format: Journal Article
• Language: English; Portuguese
• Published: Brazil 01.07.2010
• Subjects: Adult; Aged; Aged, 80 and over; Female; Hospital Mortality; Humans; Male; Middle Aged; Myocardial Infarction - complications; Retrospective Studies; Risk Factors; Vasoconstrictor Agents - therapeutic use; Ventricular Septal Rupture - drug therapy; Ventricular Septal Rupture - etiology; Ventricular Septal Rupture - mortality; Ventricular Septal Rupture - surgery
• DOI: 10.1590/S0102-76382010000300010

To study clinical features, complications and in-hospital outcomes of patients operated for postinfarction ventricular septal rupture. A retrospective study involving 21 patients between January/1996 and June/2009. All operations were performed at the Division of Cardiovascular Surgery of Complexo Hospitalar HUOC/PROCAPE. Mean age of patients was 62.81 years (± 8.21), 61.9% (n = 13) were male. Rupture occurred on average 4.8 days after infarction. Cardiogenic shock was observed in 57.1% (n = 12), being risk factor for death (100% with shock vs. 22.2% without shock; P<0.001). Survivors had a higher mean ejection fraction compared to deaths (66.29% ± 4.61% versus 42.71% ± 4.79%, P <0.001). All were classified as high risk by the EuroSCORE, and the survivors had lower average score compared to deaths (6.57 ± 0.53 versus 10.93 ± 2.23; P <0.001). The majority (76.2%, n = 16) of the patients needed to use vasoactive drugs and 57.1% (n = 12) considered hemodynamically unstable. Need for vasoactive drugs was a risk factor for death (81.3% with vasoactive drugs versus 20% without vasoactive drugs, P = 0.025). Hemodynamic instability was also a risk factor for death (100% in the unstable group versus 22.2% in the stable group; P <0.001). The rate of in-hospital mortality was 66.7% (n = 14). The need for vasoactive drugs, hemodynamic instability and cardiogenic shock were associated with higher rates of mortality. Patients who had adverse outcomes had less ventricular function and higher score in the EuroSCORE. Mortality remains high.