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Predictors of Mortality in Primary Surgical Repair of Postinfarction Ventricular Septal Defects: The Leipzig
Maximilian Vondran1, Jens Garbade2, Sven Lehmann3
1University Department for Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany. maximilian.vondran@gmx.de.
Insights
Postinfarction ventricular septal defect (pVSD) after acute myocardial infarction (AMI) has high mortality. Preoperative cardiogenic shock and early surgery (<7 days) significantly increase 30-day mortality risk.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Outcomes
Background:
- Postinfarction ventricular septal defect (pVSD) is a severe complication of acute myocardial infarction (AMI).
- pVSD is associated with substantial mortality, necessitating identification of prognostic factors.
- Surgical repair is the primary treatment, but outcomes vary.
Purpose of the Study:
- To identify predictors of early (30-day) and long-term mortality in patients undergoing primary surgical repair of pVSD.
- To evaluate the impact of various surgical techniques on patient outcomes.
Main Methods:
- Retrospective analysis of prospectively collected data from 77 consecutive patients with pVSD.
- Assessment of demographic and perioperative variables.
- Statistical analysis to determine independent risk factors for mortality.
Main Results:
- 30-day mortality was 42.8%.
- Independent predictors of 30-day mortality included surgery within 7 days of AMI, absence of preoperative diuretics, and preoperative cardiogenic shock.
- Surgical technique and materials did not significantly influence outcomes.
Conclusions:
- 30-day mortality for pVSD remains high.
- Preoperative cardiogenic shock is a significant predictor of mortality.
- Current surgical techniques and materials did not demonstrate a differential impact on outcomes in this cohort.
Background:
A postinfarction ventricular septal defect (pVSD) as a complication of acute myocardial infarction (AMI) is associated with high mortality. This retrospective, single-center study aimed to identify predictors of early and long-term outcomes in patients undergoing primary surgical repair of pVSD managed by various surgical techniques.
Methods:
We reviewed data from 77 consecutive patients who underwent primary surgical repair after pVSD in our institution. Prospectively collected demographic and perioperative data were analyzed retrospectively. Predictors of 30-day mortality and long-term outcome were assessed.
Results:
pVSD was anterior in 45 patients (58.4%) and posterior in 32 (41.6%). Buttressed mattress suture (n = 9, 11.7%), simple single septal patch (n = 34, 44.2%), simple double septal patch (n = 2, 2.6%), sandwich double patch (n = 1, 1.3%), and the infarct exclusion technique (n = 31, 40.3%) were performed for surgical closure. Fifty-three patients (68.8%) had preoperative cardiogenic shock. The 30-day mortality was 42.8% (33 patients). Independent risk factors of 30-day mortality were duration between AMI and surgery <7 days (odds ratio [OR] 5.229, P = .011), preoperative absence of diuretics (OR 6.913, P = .005), and preoperative cardiogenic shock (OR 3.558, P = .011). Cumulative survival rates at 1, 5, and 10 years were 57.1%, 57.1%, and 31.2%, respectively.
Conclusion:
In pVSD, the 30-day mortality remains high, and preoperative cardiogenic shock significantly influenced mortality in our study. None of the surgical techniques or materials used in our investigation influenced the outcome.