Re-repair of post-myocardial infarction ventricular septal rupture

Survivors of post-myocardial infarction (MI) ventricular septal rupture (VSR) repair may require reintervention if initial repairs are incomplete or fail. We assessed patients undergoing post-MI VSR re-repair.

Between January 1976 and July 2023, 38 consecutive patients underwent re-repair of post-MI VSR at Cleveland Clinic. Preoperative characteristics, operative details, and postoperative outcomes were obtained through medical records review, and patients were followed for survival.

Thirty-two (84%) re-repairs were elective/urgent, and 6 (16%) were emergencies. Preoperative temporary mechanical circulatory support was used in 14 (37%), with 12 isolated intra-aortic balloon pumps. Indications for re-repair were recurrent VSR detected during postoperative surveillance (n = 25; 66%) and residual VSR after incomplete initial repair (n = 13; 34%). The median time from initial repair to re-repair was 55 days (15th/85th percentiles: 5-331 days). Two patients (5.3%) had residual or recurrent VSR after re-repair but received no intervention due to hemodynamic insignificance. Postoperative complications included sepsis (n = 7; 18%), stroke (n = 6; 16%), and new-onset dialysis (n = 6; 16%). Operative mortality was 32% (n = 12), with differences between patients who underwent surgery before January 2001 (n = 10/18; 56%) and those who did so after January 2001 (n = 2/20; 10%), as well as between patients who received preoperative temporary mechanical circulatory support (n = 8/14; 57%) and those who did not (n = 4/24; 17%).

Patients with failed or incomplete initial post-MI VSR repairs may be considered for re-repair, as modern-day improvements in perioperative care may be associated with more favorable outcomes. Referral to an expert tertiary center should be considered owing to the surgical complexity of re-repair.