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Management and outcomes of ventricular septal defects after acute myocardial infarction: A multicenter retrospective
Pierre-Guillaume Piriou1, Patrice Guerin1, Julien Plessis1
1Department of Cardiology, Nantes Université, CHU Nantes, l'institut du thorax, Nantes, France.
Insights
Surgery for post-myocardial infarction (MI) ventricular septal defects (VSDs) is risky but improves survival. Despite advances, mortality for post-MI VSD remains high, with cardiogenic shock and cardiac arrest as key risk factors.
Area of Science:
- Cardiology
- Cardiac Surgery
- Critical Care Medicine
Background:
- Post-myocardial infarction (MI) ventricular septal defects (VSDs) are associated with high mortality.
- The optimal management strategy and surgical benefit for post-MI VSD remain unclear.
Purpose of the Study:
- To investigate the management and outcomes of patients with post-MI VSD over a 10-year period.
- To compare surgical versus medical treatment outcomes in a large cohort.
Main Methods:
- Retrospective, multicenter study of 92 patients with post-MI VSD from 2008-2019.
- Comparison of characteristics and outcomes between surgically treated and medically treated groups.
- Analysis of mortality risk factors, survival curves at 30 days and 1 year.
Main Results:
- 50 patients underwent surgery, 42 received medical treatment; all were critically ill.
- 1-year mortality was 46% with surgery versus 83.3% with medical treatment (p < .001).
- Cardiogenic shock and cardiac arrest were identified as mortality risk factors.
Conclusions:
- Surgical intervention for post-MI VSD, despite risks, significantly improves 1-year survival.
- Overall mortality for post-MI VSD has not demonstrably improved over the past decade.
Background And Aim:
The mortality rate of patients with post-myocardial infarction (MI) ventricular septal defects (VSDs) is high, and the benefit of surgery is unclear. We aimed to investigate the management and outcomes of post-MI VSD over a 10-year period in a large cohort.
Methods:
Data of patients with post-MI VSD admitted in three French university hospitals from 2008 to 2019 were examined. The characteristics of those who underwent surgery were compared with those who received medical treatment. Mortality risk factors, survival curves, and outcomes at 30 days and 1 year after treatment were determined.
Results:
Of the 92 patients whose data were examined, 50 underwent surgery and 42 received exclusive medical treatment. All patients were critically ill. Overall, 76.1% of patients received inotropic support, and 63% received mechanical ventilation. Circulatory assistance, mainly via intra-aortic balloon pump and extra-corporeal membrane oxygenation, was provided to 46.7% patients, with 14.1% requiring a second assistance. The median time to surgery was 4 days. At 1 year, mortality was 46% in those who underwent surgery and 83.3% in those treated medically (p < .001). Survival curves at 1 and 3 months showed major differences, and the survival rate showed little change 30 days after treatment. Cardiogenic shock and cardiac arrest emerged as risk factors for mortality.
Conclusions:
In our retrospective, multicenter study, the mortality resulting from post-MI VSD did not seem to improve over the last decade. Although surgery carried considerable risks, it improved survival.
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