Evolution in the management of postinfarct ventricular septal defects from surgical to percutaneous approach: a
Janarthanan Sathananthan1, Peter Ruygrok
1Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand. janar.s@hotmail.com
Background:
Postinfarction ventricular septal defect (VSD) is an uncommon but serious complication of myocardial infarction associated with high mortality. While traditionally postinfarct VSDs were only closed surgically, percutaneous closure is a newer treatment strategy that has been introduced with success in recent years. We sought to assess trends in treatment choice at our center.
Methods And Results:
A single-center, retrospective study design included all patients treated for postinfarction VSDs, either surgically or percutaneously, from January 1992 to December 2012. Percutaneous closure was performed using the self-expandable, double-disc Amplatzer closure device. Over the 20-year study period, a total of 25 patients were treated for postinfarct VSDs, with 18 managed surgically and 7 managed percutaneously. Two patients with an initial surgical repair experienced patch dehiscence and were subsequently treated percutaneously, bringing the number in this group to 9. The use of surgical closure declined over time, with percutaneous closure being the only treatment strategy used from 2004 onward. Mortality rates were 44% and 75% for those with final percutaneous and surgical closure, respectively (P<.13). Mortality rates in patients presenting with and without cardiogenic shock were 80% and 46%, respectively (P<.05).
Conclusion:
Percutaneous closure has become the preferred treatment of postinfarct VSDs at our center. Percutaneous closure may be a viable and non-inferior treatment strategy compared to traditional surgical closure.
