Clinical Outcomes for Postinfarct Ventricular Septal Defect Repair in a Large State-Wide Surgical Registry

Area of Science:

• Cardiology
• Cardiac Surgery

Background:

• Ventricular septal defect (VSD) is a severe complication of acute myocardial infarction (AMI).
• Delayed presentation of AMI increases VSD risk and mortality.
• Surgical repair outcomes for post-AMI VSD require further investigation.

Purpose of the Study:

• To assess clinical characteristics and mortality following surgical repair of post-AMI VSD.
• To evaluate trends in mortality, mechanical circulatory support (MCS) device use, and surgical approaches.
• To identify factors associated with in-hospital mortality after VSD repair.

Main Methods:

• Retrospective analysis of 79 patients undergoing surgical VSD repair post-AMI (May 2008-Jan 2020).
• Univariate and multivariable logistic regression models used to analyze in-hospital mortality.
• Key variables analyzed included age, ejection fraction, cardiogenic shock, MCS use, and surgical timing.

Main Results:

• In-hospital mortality was 35% (28/79 patients).
• Cardiogenic shock (79% vs 39%) and MCS device use (54% vs 4%) were significantly associated with mortality.
• Emergent surgery (71% vs 18%) and renal failure (48% vs 19%) also correlated with higher mortality.

Conclusions:

• Surgical repair of post-AMI VSD carries a high mortality rate, strongly linked to cardiogenic shock and MCS requirement.
• Emergent surgery and postoperative renal failure are critical indicators of poor outcomes.
• Improved patient selection via a Heart Team approach and novel therapies are essential for managing these complex cases.