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Updated: Dec 25, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Repair of ischemic ventricular septal defect with and without coronary artery bypass grafting
Dylan P Horan1, Thomas J O'Malley1, Matthew P Weber1
1Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
Insights
Coronary artery bypass grafting (CABG) during ventricular septal defect (VSD) repair after myocardial infarction (MI) did not significantly impact survival. Decisions regarding revascularization should balance benefits against the risks of extended cardiopulmonary bypass.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Ventricular septal defect (VSD) following myocardial infarction (MI) is a rare but serious complication associated with high mortality.
- Optimal management strategies for post-MI VSD, particularly the role of concomitant coronary artery bypass grafting (CABG), remain debated.
Purpose of the Study:
- To evaluate the impact of concomitant CABG on outcomes in patients undergoing repair for post-MI VSD.
- To analyze survival data and identify factors influencing mortality in this patient population.
Main Methods:
- A systematic review and meta-analysis of 67 studies published between 2000 and 2018.
- Inclusion of 2174 patients with post-MI VSD, extracting demographic, perioperative, and survival data.
- Comparison of outcomes between patients who received concomitant CABG and those who did not.
Main Results:
- Single-vessel disease was most common (47%), with the left anterior descending artery most frequently involved (55%).
- Concomitant CABG was performed in 52% of patients; revascularization of the infarcted territory occurred in 54% of these cases.
- Thirty-day mortality was significantly lower in patients with a preoperative coronary angiogram (30%) compared to those without (58%). No significant survival difference was observed between patients with or without concomitant CABG.
Conclusions:
- Concomitant CABG does not significantly affect survival rates after post-MI VSD repair.
- The decision to perform revascularization should carefully consider the potential risks associated with prolonged cardiopulmonary bypass time.
Background And Aim Of The Study:
Ventricular septal defect (VSD) following myocardial infarction (MI) is a relatively infrequent complication with high mortality. We sought to investigate the effect of concomitant coronary artery bypass graft (CABG) on outcomes following post-MI VSD repair.
Methods:
Electronic search was performed to identify all relevant studies published from 2000 to 2018. Sixty-seven studies were selected for the analysis comprising 2174 patients with post-MI VSD. Demographic information, perioperative variables, and outcomes including survival data were extracted and pooled for systematic review and meta-analysis.
Results:
Single-vessel disease was most common (47%, 95% confidence interval [CI], 42-52), left anterior descending coronary artery was the most commonly involved vessel (55%, 95% CI, 46-63), and anterior wall was the most commonly affected territory (57%, 95% CI, 51-63). Concomitant CABG was performed in 52% (95% CI, 46-57) of patients. Of these, infarcted territory was re-vascularized in 54% (95% CI, 23-82). A residual/recurrent shunt was present in 29% (95% CI, 24-34) of patients. Of these, surgical repair was performed in 35% (95% CI, 28-41) and transcatheter repair in 11% (95% CI, 6-21). Thirty-day mortality was 30% (95% CI, 26-35) in patients who had preoperative coronary angiogram, and 58% (95% CI, 43-71) in those who did not (P < .01). No significant survival difference observed between those who had concomitant CABG vs those without CABG.
Conclusions:
Concomitant CABG did not have a significant effect on survival following VSD repair. Revascularization should be weighed against the risks associated with prolonged cardiopulmonary bypass.
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