Acute ischaemic ventricular septal defect--a formidable surgical challenge

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Critical Care Medicine

Background:

• Acute Ischaemic Ventricular Septal Defect (VSD) is a severe complication following myocardial infarction.
• Surgical intervention for acute VSD presents significant challenges and high mortality rates.

Purpose of the Study:

• To evaluate surgical outcomes for Acute Ischaemic Ventricular Septal Defect (VSD).
• To establish practice guidelines for the management of acute VSD.

Main Methods:

• Retrospective analysis of 36 patients undergoing surgery for acute VSD between 1992 and 2006.
• Data reviewed included patient demographics, presentation, surgical techniques, morbidity, and mortality.
• Statistical analysis was performed to identify predictors of mortality and inform guidelines.

Main Results:

• The overall early mortality rate was 52.78%, with significantly higher mortality for inferior VSD (85.71%) compared to anterior VSD (31.82%).
• Pre-operative shock (OR 6.7) and inferior VSD location (OR 7.7) were strong predictors of mortality.
• Recurrent VSD occurred in 11 patients, with some requiring re-operation or percutaneous device closure.

Conclusions:

• Acute Ischaemic VSD is a critical surgical condition associated with high mortality and residual shunts.
• Surgery for patients with inferior VSD and pre-operative shock should be reserved for exceptional circumstances due to prohibitive mortality rates.