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Percutaneous Closure of Post-Infarction Ventricular Septal Defects-An Over Decade-long Experience
Robert Sabiniewicz1, Zenon Huczek2, Karol Zbroński2
1Department of Pediatric Cardiology and Congenital Heart Disease, Medical University of Gdańsk, Gdańsk, Poland.
Insights
Percutaneous post-infarction ventricular septal defect (PIVSD) closure is feasible in selected patients, offering a good survival rate. Technical success significantly improves survival, though optimal timing remains debated.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Post-infarction ventricular septal defects (PIVSD) present a significant clinical challenge with high mortality rates.
- Limited data exists on the efficacy and outcomes of interventional closure for PIVSDs.
Purpose of the Study:
- To evaluate the long-term experience with percutaneous closure of post-infarction ventricular septal defects (PIVSD).
- To assess the feasibility, success rates, and survival outcomes of this interventional procedure.
Main Methods:
- A retrospective analysis of percutaneous PIVSD closures performed between 2003 and 2016 across 8 centers.
- Patients were categorized into acute (≤14 days) and non-acute (>14 days) phases based on VSD diagnosis to closure time.
Main Results:
- Twenty-one procedures were performed on 20 patients (mean age 70 years), with 33% in the acute phase.
- Technical success was achieved in 81% of cases, with an overall 30-day survival rate of 70%.
- Technical success (HR 0.13) and lower white blood cell count (HR 1.36) were associated with reduced 30-day mortality.
Conclusions:
- Percutaneous PIVSD closure is a feasible option in selected patients, yielding satisfactory survival rates.
- Procedural success positively impacts survival; however, the optimal timing for closure remains controversial.
- Non-acute phase closure showed lower mortality but may involve patient selection bias, necessitating larger registry studies.
Objectives:
To report an over decade-long experience with percutaneous post-infarction ventricular septal defect (PIVSD) closure.
Background:
PIVSDs remains a major clinical challenge with extremely high mortality. Data concerning interventional closure of PIVSD is scarce.
Methods:
All percutaneous PIVSD closures performed between 2003 and 2016 in 8 participating centres were identified. Data concerning patients and procedures was acquired. Patients were divided into two groups, based on the time interval between VSD diagnosis and closure (≤14 days-acute phase, >14 days-non-acute phase).
Results:
Twenty-one percutaneous PIVSD closures were performed on 20 patients (9 females, mean age: 70 years). Mean interval between the diagnosis and the procedure was 182.6 ± 500 days (range: 7-2228). Defects were mostly located in apical (55%) segments of the septum. In 7 cases (33%) the procedure was performed in the acute phase. The closure was technically successful in 17 cases (81%). Four patients died within 48 hours after the procedure. 30-days survival rate of the entire cohort was 70%. Univariate analysis revealed impact of technical success of the procedure (HR 0.13, CI 0.03-0.68 P = 0.016) and white blood cell count (HR 1.36 per unit increase, CI 1.1-1.69, P = 0.005) on 30-day mortality.
Conclusions:
In a selected population of patients percutaneous PIVSD closure is feasible and provides satisfactory survival rate. Procedural success has a protective impact on survival. Timing of the closure remains controversial. Procedure in the non-acute phase carries lower mortality, but at the same time introduces a selection bias. Larger registry-based studies are required.
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