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Surgical Outcomes of Post-myocardial Infarction Ventricular Septal Defect/Rupture: A Systematic Review and
Soumitra Ghosh1, Vikram Halder2, Amit Mishra2
1Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, IND.
Insights
Surgical repair of ventricular septal defect (VSD) after myocardial infarction (MI) improves survival, but outcomes remain poor. This analysis of 40 studies highlights significant risks and high mortality rates in post-MI VSD patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Outcomes Research
Background:
- Ventricular septal defect (VSD) is a severe complication of acute myocardial infarction (MI).
- Despite surgical advancements, post-MI VSD carries a high mortality rate.
- Clinical outcomes for post-MI VSD are complex and variable.
Purpose of the Study:
- To evaluate surgical outcomes and associated risks in patients with post-MI VSD.
- To analyze pooled data from existing literature on post-MI VSD management.
- To identify factors influencing mortality and survival in this patient population.
Main Methods:
- Systematic literature review of 40 studies.
- Bayesian hierarchical models for estimating pooled proportions (cardiogenic shock, 30-day survival, mortality).
- Risk difference estimation for MI/VSD location and mortality with CABG; heterogeneity and publication bias tests (Egger's, Begg's).
Main Results:
- Significant risk differences observed for anterior vs. posterior MI/VSD locations (0.23 and 0.27).
- Pooled 30-day survival: 54.43%; pooled mortality: 48.22%.
- High heterogeneity noted (I2 >90%, p<0.0001); no significant publication bias detected.
Conclusions:
- Surgical management of post-MI VSD is associated with improved outcomes.
- Despite surgical intervention, post-MI VSD remains a condition with a high mortality rate.
- Further research is needed to optimize treatment strategies for post-MI VSD.
Abstract:
Ventricular septal defect (VSD) is a catastrophic acute myocardial infarction (MI) complication. Despite a significant reduction in the prevalence of post-MI VSD with the advancement of surgical techniques, it is still considered fatal with a high mortality rate. The trends in the clinical outcomes of patients with post-MI VSD show discretion due to the complexity of the disease. Therefore, the present analysis aimed to evaluate the surgical outcomes and associated risks in the patients of post-MI VSD. A thorough literature survey resulted in 40 studies of our interest. The pooled proportion of differential variables, including the incidence of cardiogenic shock, 30-day survival, and overall mortality, were estimated using Bayesian hierarchical models. The risk difference was estimated for the location of MI and VSD and mortality in patients with coronary artery bypass graft (CABG). In addition, the heterogeneity tests for inconsistency and publication biases using Egger's and Begg's tests were also estimated. The analysis revealed a significant risk difference of 0.23 and 0.27 for the anterior vs. posterior location of MI and VSD, respectively. Further, the pooled proportion of 30-day survival and mortality was found to be 54.43% (95% credible interval (CI): 52.88-55.98%) and 48.22% (95% CI: 4-12.3%), respectively. Moreover, the heterogeneity test revealed significant inconsistencies in all the datasets with an I2 index of >90% (p<0.0001). Lastly, the publication bias results suggested no evidence of asymmetry and small-study effects. Conclusively, the surgical management of post-MI VSD patients is considered beneficial; however, the outcomes signify its fatal behavior.
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