Outcome of Surgical Repair of Post-Infarction Ventricular Septal Rupture: A Single Center Observational Study

To review the experience of surgical repair of post-infarction ventricular septal rupture (VSR) and analyze the associated outcomes in National Heart Foundation Hospital & Research Institute (NHFH & RI). This retrospective review was performed on 19 consecutive cases who had undergone surgical repair of post-infarction VSR between 2009 and 2017. Continuous variables were summarized as mean plus/minus the standard deviation or median. Categorical variables were expressed as percentage of the sample. Comparison between in-hospital survivors versus non-survivors was performed by Student's t-test and chi-square or Fisher's exact test for continuous and categorical variables respectively. A value of p<0.05 was considered statistically significant. Mean age of survivor and non-survivors were 53.53±9.2 and 56.33±1.5 years consecutively. Anterior VSR 14(73.6%) was more common than posterior VSR 5(26.4%). All patients had significant coronary lesions; the frequency of 1-, 2-, and 3-vessel disease was 22.2%, 27.7% and 50.0% consecutively. The left anterior descending coronary artery was the infarct-related artery in all patients with anterior VSR. Mean cardiopulmonary bypass time was 157±58.6 minutes and 249±78.3 minutes in survivor and non-survivor groups consecutively (p=0.018). Operative mortality within 30 days was 21%. Low output syndrome (LOS), multiple organ failure (MOF), septicemia, tracheostomy and prolonged intensive care unit (ICU) stay were the major factor for survivals. Surgical repair of post-infarction VSR carries a high operative mortality. But, stable hemodynamic at the time of VSR diagnosis is a significant predictor of survival and concomitant coronary artery bypass grafting (CABG) improves early survival.