[Analysis of mortality relative factors in patients with ventricular septal rupture complicating myocardial
1Center of Cardiac Intensive Care, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Insights
Surgery effectively treats ventricular septal rupture after myocardial infarction. Key factors influencing mortality include advanced age, severe heart dysfunction, renal failure, tricuspid regurgitation, and delayed surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Critical Care Medicine
Background:
- Ventricular septal rupture (VSR) is a severe complication of myocardial infarction (MI).
- Prompt surgical intervention is crucial for managing VSR post-MI.
- Identifying factors associated with mortality is essential for improving patient outcomes.
Purpose of the Study:
- To investigate the in-hospital mortality rate associated with VSR in MI patients.
- To identify independent risk factors for in-hospital mortality in this patient cohort.
Main Methods:
- Retrospective analysis of 51 patients with MI complicated by VSR who underwent surgery.
- Data collected between January 2005 and December 2018.
- Statistical analysis included t-tests, chi-squared tests, and logistic regression for mortality factors.
Main Results:
- Overall in-hospital mortality was 15.7% (8/51 patients).
- Mortality risk was significantly higher for operations performed within 1 week (66.7%) compared to over 4 weeks (6.5%).
- Independent predictors of mortality included advanced age, NYHA class IV, severe tricuspid regurgitation, pre-operative renal failure, and surgery within 1 week of VSR.
Conclusions:
- Surgical intervention is an effective treatment for VSR complicating MI.
- Timely surgical intervention, ideally after 4 weeks, can significantly reduce mortality.
- Advanced age, severe cardiac dysfunction, renal failure, and severe tricuspid regurgitation are critical factors impacting survival.
Abstract:
Objective: To examine the mortality rate and relative factors associate with ventricular septal rupture in myocardial infarction patients. Methods: A total of 51 patients who suffered from myocardial infarction complicating with ventricular septal rupture received operative procedures between January 2005 and December 2018 in Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, were retrospectively analyzed. There were 34 males and 17 females, with an age of (63±8) years (range: 44 to 82 years). The time between ventricular septal rupture and surgical procedure was (44±39) days (range: 3 to 187 days). The t test and χ(2) test were used for univariate analysis, Logistics regression model was used for multivariate analysis of in-hospital mortality relative factors. Results: There were 8 patients dead in hospital, 43 patients survived, the overall mortality rate was 15.7% in hospital. The post-operation mortality rate was 2/3 of who suffered ventricular septal rupture and underwent operation within 1 week, but it's markedly decreased to 6.5% if the time over 4 weeks. Univariate analysis showed that renal failure before operation, creatinine before operation, left ventricular ejection fraction, cardiac function (New York Heart Association) grade Ⅳ, severe tricuspid regurgitation, dialysis post-operation, creatinine of the first day of post-operation, the time between and operation more than 4 weeks were in-hospital mortality relative factors. Multivariate analysis reflected that advanced age (OR=1.32, 95%CI: 1.05 to 1.75, P=0.033), cardiac function grade Ⅳ (OR=2.25, 95%CI: 1.62 to 2.82, P=0.003), severe tricuspid regurgitation (OR= 1.82, 95%CI: 1.31 to 2.43, P=0.001), renal failure before operation (OR=1.78, 95%CI: 1.26 to 2.32, P=0.015), the time between ventricular septal rupture and operation less than 1 week (OR=2.50, 95%CI: 1.52 to 2.98, P=0.012), were independent in-hospital mortality relative factors. Conclusions: The surgery operation is an effective way to deal with ventricular septal rupture combined with myocardial infarction. The independent relative factors of in-hospital mortality are advanced age, cardiac function grade Ⅳ, renal failure before operation, severe tricuspid regurgitation, the time between ventricular septal rupture and operation less than 1 week.
