FACTORS AFFECTING OUTCOME AND SURVIVAL AFTER SURGICAL REPAIR OF POST-INFARCTION VENTRICULAR SEPTAL DEFECT

Abstract

ABSTRACT
Objective: To review the experience of surgical repair of post-infarction
ventricular septal rupture (VSR) and analyze the associated outcomes and
prognostic factors.
Methodology: A retrospective review was performed on 38 consecutive patients
who had undergone surgical repair of post- infarction VSD between 2002 and
2012. Continuous variables were expressed as either mean ± standard deviation
or median with 25th and 75th percentiles. These were compared using two-tailed
t-test or Mann–Whitney U test respectively. A two-tailed p-value < 0.05 was
used to indicate statistical significance.
Results: Mean age was 46.5 ± 5.9 years, all patients were males. The VSD was
anterior in 19 (82.6%) and posterior in 4 patients. Median interval from
myocardial infarction to VSR was 1 day (1-4). Pre-operative intra-aortic balloon
pump was inserted in 37 patients (97.8%). Thirty-six patients (94.7%)
underwent coronary angiography. All patients underwent patch repair. Mean
aortic cross clamp time was 68 ± 34minutes and mean cardiopulmonary
bypass time was 132 ± 44 minutes. Coronary artery bypass grafting (CABG)
was performed in 15 patients (65%), with a mean of 1.5 ± 0.7 distal
anastomoses. Operative mortality within 30 days was 43.5%. Univariate analysis
identified emergency surgery, New York Heart Association (NYHA) class,
inotropic support, right ventricular dysfunction, EuroSCORE II, intra-operative red
cell transfusion, post-operative renal failure and renal replacement therapy (RRT)
as predictors of operative mortality.
Conclusions: Surgical repair of post-infarction VSD carries a high operative
mortality. NYHA class at presentation and post-operative RRT are predictors of
early mortality. Concomitant CABG does not improve survival.