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Role of myocardial revascularization in postinfarction ventricular septal rupture
R Prêtre1, Q Ye, J Grünenfelder
1Clinic for Cardiovascular Surgery, University Hospital Zürich, Switzerland. rene.pretre@chi.usz.ch
Insights
Urgent closure of postinfarction ventricular septal rupture is crucial. Coronary angiography and revascularization in patients with associated coronary artery disease improve outcomes.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Surgery
Background:
- Postinfarction ventricular septal rupture necessitates prompt surgical intervention.
- The necessity of routine coronary angiography and revascularization in these patients remains unclear.
Purpose of the Study:
- To evaluate the impact of systematic coronary angiography and selective coronary revascularization on outcomes in patients with postinfarction ventricular septal rupture.
Main Methods:
- A retrospective review of 54 patients undergoing patch closure for postinfarction ventricular septal defect.
- Systematic coronary angiography was performed, with myocardial revascularization reserved for cases with significant coronary artery stenosis.
Main Results:
- Coronary angiography did not lead to mortality or deterioration. 28 patients had associated coronary artery disease requiring revascularization, typically with venous grafts.
- Operative and late mortality rates were not significantly different between patients with and without associated coronary artery disease, with similar survival curves up to 8 years.
Conclusions:
- Myocardial revascularization effectively mitigates the risks associated with concurrent coronary artery disease postoperatively and in the medium term.
- Hemodynamically stable patients with postinfarction ventricular septal rupture should undergo coronary angiography, with revascularization performed if significant stenosis is identified.
Background:
Postinfarction ventricular septal rupture requires urgent closure. The role of systematic coronarography and coronary revascularization needs clarification.
Methods:
Fifty-four patients who underwent patch closure of postinfarction ventricular septal defect were reviewed. A coronarography had been systematically and myocardial revascularization selectively (when significant coronary artery stenosis existed) performed.
Results:
No patient died or deteriorated during coronarography. Twenty-six patients showed no coronary artery disease besides the infarct-related artery, and 28 had associated disease. Threatened myocardial territories were revascularized usually with venous grafts (mean number of distal anastomosis, 2.5). Operative mortality was 19% and 32% (p = 0.36) and late mortality 43% and 53% (p = 0.75) in patients without and in patients with associated coronary artery disease, respectively. Survival curve in both group was similar, at least up to 8 years after operation.
Conclusions:
Myocardial revascularization controlled the added risk of associated coronary artery disease in the postoperative period and in median term. A coronarography should be performed in all patients who can be stabilized hemodynamically and myocardial revascularization performed in case of significant stenosis.