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The Annals of Thoracic Surgery, Vol 57, 1244-1247, Copyright © 1994 by The Society of Thoracic Surgeons

ARTICLES

Postinfarction ventricular septal defect in the elderly: analysis and results

C Blanche, SS Khan, A Chaux and JM Matloff
Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048.

Fifteen elderly patients (age more than 70 years) underwent surgical repair of postinfarction ventricular septal defects during the years 1980 through 1992. The operative (to discharge or < 30 days) mortality rate was 47%, and the complication rate among survivors was 63%. The probability of survival at 1 year was 47% +/- 13%. Because of the small sample size of our patient population, predictive preoperative risk factors associated with early mortality could not be identified with certainty. However, there is a trend suggesting that high right atrial pressures (p = 0.15) and the need of an intraaortic balloon pump preoperatively (p = 0.12) influence 30-day mortality, as previously described in larger series. Of 5 long-term survivors, 3 are in New York Heart Association functional class I and 2 are in class II. Our experience in this group of patients suggests that in the elderly, a very aggressive approach should be taken in recommending early surgical intervention for postinfarction ventricular septal defect before hemodynamic deterioration ensues and severely compromises chances for survival.


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