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.