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Derek D. Muehrcke
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Ann Thorac Surg 1992;54:876-883
© 1992 The Society of Thoracic Surgeons

Articles

Postinfarct ventricular septal defect repair: Effect of coronary artery bypass grafting

Derek D. Muehrcke, MD, Willard M. Daggett, Jr, MD*, Mortimer J. Buckley, MD, Cary W. Akins, MD, Alan D. Hilgenberg, MD, W.Gerald Austen, MD

Surgical Cardiovascular Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA

* Address reprint requests to Dr Daggett, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114.

Between June 1968 and April 1991, 75 patients who had undergone coronary angiography underwent repair of a postinfarction ventricular septal defect. Group 1 (n = 33) includes patients who had two- or three-vessel serious (>75% narrowing) proximal coronary artery disease and underwent complete revascularization in addition to repair of the ventricular septal defect. Group 2 (n = 19) patients also had two- or three-vessel coronary artery disease but bypass grafting was not performed; only the ventricular defect was repaired. Group 3 (n = 23) patients had only single-vessel coronary artery disease that corresponded to the region of the infarct; they underwent ventricular septal defect repair only. Follow-up of hospital survivors was 96% complete at a mean of 86.2 months (range, 1 to 288 months). Hospital mortality after ventricular septal defect repair was 21.2% in the cohort with bypassed coronary artery disease (group 1), 26.3% in those with unbypassed disease (group 2), and 26.1% in those with only single-vessel coronary artery disease (group 3) (p = 0.88). With follow-up after 5 and 10 years, the actuarial survival was 72.2% ± 8% and 47.8% ± 10%, respectively, in the bypassed group, 29.2% ± 11% and 0%, respectively, in the unbypassed group, and 52.2% ± 10% and 36.5% ± 11%, respectively, in the cohort with single-vessel disease. Bypassing associated coronary artery disease significantly increased long-term survival when compared with patients with unbypassed coronary artery disease (p = 0.0015).




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