Surgical repair of postinfarction ventricular septal rupture: Risk factors of early and late death

Objective

The aim of the study was to identify risk factors of early and late death after surgical repair of postinfarction ventricular septal rupture.

Methods

During a 25-year period, from May 1981 to August 2006, 102 patients underwent repair of postinfarction ventricular septal rupture. Data were collected on clinical, angiographic, and echocardiographic findings; operative procedures; early morbidity; and survival time. Univariable and multivariable analyses were performed to identify risk factors of 30-day mortality and total mortality.

Results

Thirty-day mortality was 33% altogether and decreased from 45% in the first half to 21% in the second half of the period (P = .01). Follow-up was a mean of 5.2 ± 6.2 years and a median of 2.9 years (range, 0–26.3 years). Five- and 10-year cumulative survival was 50% and 32%, respectively. Shock at surgical intervention and incomplete coronary revascularization were strong and independent risk factors of both 30-day mortality and poor long-term survival.

Conclusions

Early outcome after repair of ventricular septal rupture improved significantly during time, with 30-day mortality being 21% in the last decade. Five- and 10-year cumulative survival was 50% and 32%, respectively. Shock at surgical intervention and incomplete coronary revascularization were strong and independent predictors of poor early and late survival.

Abbreviations and Acronyms: AMI, acute myocardial infarction, ASAT, aspartate aminotransferase, CABG, coronary artery bypass grafting, CPB, cardiopulmonary bypass, IABP, intra-aortic balloon pump, PCI, percutaneous coronary intervention, VSR, ventricular septal rupture

CTSNet classification: 23, 30