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Original Articles: Adult Cardiac

Long-Term Results After Surgical Repair of Postinfarction Ventricular Septal Rupture by Infarct Exclusion Technique

^a Department of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University Hospital, Frankfurt/Main, Germany
^b Center of Health Science, Institute for Biostatistics and Mathematical Modelling, Johann-Wolfgang-Goethe University Hospital, Frankfurt/Main, Germany

Accepted for publication February 6, 2009.

^_* Address correspondence to Dr Papadopoulos, Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Theodor Stern Kai 7, Frankfurt/Main, 60590, Germany (Email: nestoras.papadopoulos{at}gmail.com).

Background: Ventricular septal defect (VSD) is one of the most serious and life-threatening complications of acute myocardial infarction. The aim of this study was to evaluate the early and long-term results of the patients after surgical repair of postinfarction VSD by infarct exclusion technique.

Methods: A total of 32 consecutive patients (mean age, 62.5 ± 10.5 years) underwent postinfarction VSD repair using a standardized technique in our department. A retrospective analysis of clinical and operative data, predictors of early mortality, and long-term survival was performed. The localization of VSD was posterior in 50% and anterior in 50% of the patients.

Results: The hospital mortality was 31.2% (10 patients). The most common cause of hospital death was persistent low cardiac output. The mortality of the posterior VSD group was significantly lower than that of the anterior VSD group (18.7% and 43.7%, respectively, p = 0.01). Intra-aortic balloon pump support and absence of cardiac shock were significantly associated with a lower risk of hospital mortality (p = 0.0001 and p = 0.0009, respectively). The actuarial survival rates of in-hospital survivors at 5 and 10 years were 79% ± 2% and 51% ± 3%, respectively.

Conclusions: The repair of postinfarction VSD by the infarct exclusion is feasible and safe. This technique seems to offer sufficient favorable early and long-term results compared with other techniques. Early indication, preoperative intra-aortic balloon pump support may improve the surgical results. Preoperative cardiogenic shock carries a poor prognosis for this patient group.

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Invited Commentary

Noriyuki Tabuchi
Ann. Thorac. Surg. 2009 87: 1425. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				S. Perrotta and S. Lentini In patients undergoing surgical repair of post-infarction ventricular septal defect, does concomitant revascularization improve prognosis? Interactive CardioVascular and Thoracic Surgery, November 1, 2009; 9(5): 879 - 887. [Abstract] [Full Text] [PDF]

				N. Tabuchi Invited commentary. Ann. Thorac. Surg., May 1, 2009; 87(5): 1425 - 1425. [Full Text] [PDF]