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The Annals of Thoracic Surgery, Vol 54, 876-882, Copyright © 1992 by The Society of Thoracic Surgeons
DD Muehrcke, WM Daggett Jr, MJ Buckley, CW Akins, AD Hilgenberg and WG Austen
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).
ARTICLES
Postinfarct ventricular septal defect repair: effect of coronary artery bypass grafting
Surgical Cardiovascular Unit, Massachusetts General Hospital, Harvard Medical School, Boston 02114.
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