Postinfarction ventricular septal rupture: the Wessex experience

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Myocardial Infarction Complications

Background:

• Postinfarct ventricular septal defect (VSD) is a severe complication of myocardial infarction.
• Surgical repair of postinfarct VSD presents significant challenges and high operative mortality.

Purpose of the Study:

• To analyze the outcomes and identify risk factors for mortality in patients undergoing surgical repair of postinfarct VSD.
• To evaluate long-term survival and quality of life after surgical VSD repair.

Main Methods:

• Retrospective review of 179 patients who underwent surgical repair of postinfarct VSD between 1972 and 1995.
• Analysis of preoperative factors, operative details, and long-term survival.
• Logistic regression analysis to identify predictors of 30-day mortality.

Main Results:

• Overall operative mortality was 26.7%.
• For acute VSD, increased risk of 30-day mortality was associated with preoperative NYHA status, inferior myocardial infarction site, and longer cardiopulmonary bypass time.
• Cardiopulmonary bypass time was the only significant independent predictor of mortality on multivariate analysis.
• Five-year and 10-year survival rates were 49% and 31% (including in-hospital mortality), respectively.

Conclusions:

• Surgical repair of postinfarct VSD remains a high-risk procedure.
• Minimizing cardiopulmonary bypass time is crucial for improving survival in acute VSD.
• Survivors generally achieve a good quality of life, but no factors predicted prolonged survival.