Re-repair of post-myocardial infarction ventricular septal rupture

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Mechanical Circulatory Support

Background:

• Post-myocardial infarction (MI) ventricular septal rupture (VSR) repair may necessitate reintervention due to incomplete or failed initial repairs.
• Assessing outcomes of re-repair procedures for post-MI VSR is crucial for patient management.

Purpose of the Study:

• To evaluate the outcomes of patients undergoing re-repair for post-myocardial infarction ventricular septal rupture.
• To identify factors influencing outcomes in VSR re-repair procedures.

Main Methods:

• Retrospective review of 38 consecutive patients undergoing post-MI VSR re-repair at Cleveland Clinic from 1976 to 2023.
• Analysis of preoperative characteristics, operative details, postoperative complications, and survival rates.

Main Results:

• Re-repairs were predominantly elective/urgent (84%), with 37% receiving preoperative mechanical circulatory support.
• Indications included recurrent VSR (66%) and residual VSR (34%), with a median time to re-repair of 55 days.
• Operative mortality was 32%, significantly lower after January 2001 (10%) and in patients without preoperative support (17%).

Conclusions:

• Re-repair for failed or incomplete post-MI VSR repairs can be considered, especially with modern perioperative care improvements.
• Outcomes for VSR re-repair appear more favorable in recent eras.
• Referral to specialized tertiary centers is advised due to the complexity of these re-repair procedures.