Related Experiment Videos
Postinfarct ventricular septal defect repair: effect of coronary artery bypass grafting
D D Muehrcke1, W M Daggett, M J Buckley
1Surgical Cardiovascular Unit, Massachusetts General Hospital, Harvard Medical School, Boston 02114.
Insights
Repairing ventricular septal defects alongside coronary artery bypass grafting significantly improves long-term survival in patients with postinfarction heart conditions. This combined approach offers better outcomes than isolated defect repair for coronary artery disease patients.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Surgery Outcomes
Background:
- Postinfarction ventricular septal defect (VSD) is a serious complication.
- Associated coronary artery disease (CAD) complicates VSD repair and impacts prognosis.
- Optimal surgical strategy for VSD repair in the presence of CAD remains debated.
Purpose of the Study:
- To evaluate the impact of concomitant coronary artery bypass grafting (CABG) on survival after VSD repair.
- To compare outcomes between patients with bypassed CAD, unbypassed CAD, and single-vessel CAD undergoing VSD repair.
Main Methods:
- Retrospective analysis of 75 patients undergoing VSD repair between 1968 and 1991.
- Patients categorized into three groups: Group 1 (VSD repair + complete revascularization), Group 2 (VSD repair only, with multi-vessel CAD), Group 3 (VSD repair only, with single-vessel CAD).
- Long-term actuarial survival and hospital mortality were assessed.
Main Results:
- Hospital mortality was similar across all groups (21.2% to 26.3%).
- Actuarial survival at 5 and 10 years was significantly higher in Group 1 (72.2%/47.8%) compared to Group 2 (29.2%/0%).
- Group 3 showed intermediate survival rates (52.2%/36.5%).
Conclusions:
- Concomitant CABG in patients with multi-vessel CAD undergoing VSD repair significantly improves long-term survival.
- Surgical strategy should consider revascularization for associated CAD to enhance outcomes.
- Isolated VSD repair in the presence of significant CAD carries a poorer long-term prognosis.
Abstract:
Between June 1968 and April 1991, 75 patients who had undergone coronary angiography underwent repair of a postinfarction ventricular septal defect. Group 1 (n = 33) includes patients who had two- or three-vessel serious (> 75% narrowing) proximal coronary artery disease and underwent complete revascularization in addition to repair of the ventricular septal defect. Group 2 (n = 19) patients also had two- or three-vessel coronary artery disease but bypass grafting was not performed; only the ventricular defect was repaired. Group 3 (n = 23) patients had only single-vessel coronary artery disease that corresponded to the region of the infarct; they underwent ventricular septal defect repair only. Follow-up of hospital survivors was 96% complete at a mean of 86.2 months (range, 1 to 288 months). Hospital mortality after ventricular septal defect repair was 21.2% in the cohort with bypassed coronary artery disease (group 1), 26.3% in those with unbypassed disease (group 2), and 26.1% in those with only single-vessel coronary artery disease (group 3) (p = 0.88). With follow-up after 5 and 10 years, the actuarial survival was 72.2% +/- 8% and 47.8% +/- 10%, respectively, in the bypassed group, 29.2% +/- 11% and 0%, respectively, in the unbypassed group, and 52.2% +/- 10% and 36.5% +/- 11%, respectively, in the cohort with single-vessel disease. Bypassing associated coronary artery disease significantly increased long-term survival when compared with patients with unbypassed coronary artery disease (p = 0.0015).