Optimal surgical timing after post-infarction ventricular septal rupture

Area of Science:

• Cardiology
• Cardiac Surgery
• Interventional Cardiology

Background:

• Ventricular septal rupture (VSR) following acute myocardial infarction (AMI) presents a high-risk clinical scenario.
• Surgical VSR closure is the definitive treatment, but optimal timing and the role of mechanical circulatory support (MCS) remain debated.
• This study investigates the impact of surgical timing and MCS on prognosis in post-AMI VSR patients.

Purpose of the Study:

• To determine the ideal timing for surgical repair of VSR post-AMI.
• To evaluate the influence of mechanical circulatory support (MCS) devices on patient outcomes.
• To identify factors affecting mortality in patients undergoing surgical VSR repair.

Main Methods:

• Retrospective, multicenter observational study of 141 consecutive patients with post-AMI VSR (January 2008 - December 2018).
• Analysis of surgical timing, use of MCS (IABP, VA-ECMO), and mortality rates.
• Comparison of outcomes between early (<24 hours) and later (≥4 days) surgical interventions.

Main Results:

• Mortality was significantly lower (OR 0.3) for patients operated on from day 4 compared to those operated on within 24 hours of VSR diagnosis.
• Overall mortality was 91.5% for conservative management versus 52.3% for surgical repair (p < 0.001).
• MCS use, particularly intra-aortic balloon pump (IABP), was more frequent in surgically treated patients.

Conclusions:

• Delayed surgical repair of VSR post-AMI, specifically from day 4 onwards, is associated with lower mortality rates.
• Surgical intervention significantly improves survival compared to conservative management for post-AMI VSR.
• Further research into optimal MCS strategies alongside surgical timing is warranted.