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Ann Thorac Surg 2000;70:1444-1445
© 2000 The Society of Thoracic Surgeons

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Update

Postinfarction ventricular septal defect in the elderly: analysis and results²

^a Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA

Address reprint requests to Dr Blanche, Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Suite 6215, 8700 Beverly Blvd, Los Angeles, CA 90048
e-mail: carlos.blanche{at}cshs.org

Abstract

¹Fifteen elderly patients (age more than 70 years) underwent surgical repair of postinfarction venricular 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.