Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Surgical Repair of Ventricular Septal Defect after Myocardial Infarction: A Single Center Experience during 22 Years

  • Park, Sung Jun (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Joon Bum (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Sung-Ho (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choo, Suk Jung (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Chung, Cheol Hyun (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jae Won (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2013.04.12
  • Accepted : 2013.07.22
  • Published : 2013.12.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Surgical repair of post-infarct ventricular septal defect (VSD) is considered one of the most challenging procedures having high surgical mortality. This study aimed to evaluate the outcomes of the surgical repair of post-infarct VSD. Methods: From May 1991 to July 2012, 34 patients (mean age, $67.1{\pm}7.9$ years) underwent surgical repair of post-infarct VSD. A retrospective review of clinical and surgical data was performed. Results: VSD repair involved the infarct exclusion technique using a patch in all patients. For coronary revascularization, 12 patients (35.3%) underwent concomitant coronary artery bypass graft, 3 patients (8.8%) underwent preoperative percutaneous coronary intervention, and 9 patients (26.5%) underwent both of these procedures. The early mortality rate was 20.6%. Six patients (17.6%) required reoperation due to residual shunt or newly developed VSD. During follow-up (median, 4.8 years; range, 0 to 18.4 years), late death occurred in nine patients. Overall, the 5-year and 10-year survival rates were $54.4%{\pm}8.8%$ and $44.3%{\pm}8.9%$, respectively. According to a Cox regression analysis, preoperative cardiogenic shock (p=0.069) and prolonged cardiopulmonary bypass time (p=0.008) were independent predictors of mortality. Conclusion: The early surgical outcome of post-infarct VSD was acceptable considering the high-risk nature of the disease. The long-term outcome, however, was still dismal, necessitating comprehensive optimal management through close follow-up.

Keywords

References

  1. Crenshaw BS, Granger CB, Birnbaum Y, et al. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. GUSTO-I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) Trial Investigators. Circulation 2000;101:27-32. https://doi.org/10.1161/01.CIR.101.1.27
  2. Barker TA, Ramnarine IR, Woo EB, et al. Repair of post-infarct ventricular septal defect with or without coronary artery bypass grafting in the northwest of England: a 5-year multi-institutional experience. Eur J Cardiothorac Surg 2003; 24:940-6. https://doi.org/10.1016/S1010-7940(03)00465-2
  3. Deja MA, Szostek J, Widenka K, et al. Post infarction ventricular septal defect - can we do better? Eur J Cardiothorac Surg 2000;18:194-201. https://doi.org/10.1016/S1010-7940(00)00482-6
  4. David TE, Armstrong S. Surgical repair of postinfarction ventricular septal defect by infarct exclusion. Semin Thorac Cardiovasc Surg 1998;10:105-10. https://doi.org/10.1016/S1043-0679(98)70003-6
  5. Dalrymple-Hay MJ, Monro JL, Livesey SA, Lamb RK. Postinfarction ventricular septal rupture: the Wessex experience. Semin Thorac Cardiovasc Surg 1998;10:111-6.
  6. Lundblad R, Abdelnoor M, Geiran OR, Svennevig JL. Surgical repair of postinfarction ventricular septal rupture: risk factors of early and late death. J Thorac Cardiovasc Surg 2009;137:862-8. https://doi.org/10.1016/j.jtcvs.2008.09.008
  7. David TE, Dale L, Sun Z. Postinfarction ventricular septal rupture: repair by endocardial patch with infarct exclusion. J Thorac Cardiovasc Surg 1995;110:1315-22. https://doi.org/10.1016/S0022-5223(95)70054-4
  8. Papadopoulos N, Moritz A, Dzemali O, et al. Long-term results after surgical repair of postinfarction ventricular septal rupture by infarct exclusion technique. Ann Thorac Surg 2009;87:1421-5. https://doi.org/10.1016/j.athoracsur.2009.02.011
  9. Jeppsson A, Liden H, Johnsson P, Hartford M, Radegran K. Surgical repair of post infarction ventricular septal defects: a national experience. Eur J Cardiothorac Surg 2005;27: 216-21. https://doi.org/10.1016/j.ejcts.2004.10.037
  10. Arnaoutakis GJ, Zhao Y, George TJ, Sciortino CM, McCarthy PM, Conte JV. Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the Society of Thoracic Surgeons National Database. Ann Thorac Surg 2012;94:436-43. https://doi.org/10.1016/j.athoracsur.2012.04.020
  11. Killen DA, Piehler JM, Borkon AM, Gorton ME, Reed WA. Early repair of postinfarction ventricular septal rupture. Ann Thorac Surg 1997;63:138-42. https://doi.org/10.1016/S0003-4975(96)00765-5
  12. Deville C, Fontan F, Chevalier JM, Madonna F, Ebner A, Besse P. Surgery of post-infarction ventricular septal defect: risk factors for hospital death and long-term results. Eur J Cardiothorac Surg 1991;5:167-74. https://doi.org/10.1016/1010-7940(91)90026-G
  13. Lemery R, Smith HC, Giuliani ER, Gersh BJ. Prognosis in rupture of the ventricular septum after acute myocardial infarction and role of early surgical intervention. Am J Cardiol 1992;70:147-51.
  14. Labrousse L, Choukroun E, Chevalier JM, et al. Surgery for post infarction ventricular septal defect (VSD): risk factors for hospital death and long term results. Eur J Cardiothorac Surg 2002;21:725-31. https://doi.org/10.1016/S1010-7940(02)00054-4
  15. Cerin G, Di Donato M, Dimulescu D, et al. Surgical treatment of ventricular septal defect complicating acute myocardial infarction: experience of a north Italian referral hospital. Cardiovasc Surg 2003;11:149-54. https://doi.org/10.1016/S0967-2109(02)00190-4
  16. Cox FF, Morshuis WJ, Plokker HW, et al. Early mortality after surgical repair of postinfarction ventricular septal rupture: importance of rupture location. Ann Thorac Surg 1996; 61:1752-7. https://doi.org/10.1016/0003-4975(96)00167-1
  17. Yip HK, Fang CY, Tsai KT, et al. The potential impact of primary percutaneous coronary intervention on ventricular septal rupture complicating acute myocardial infarction. Chest 2004;125:1622-8. https://doi.org/10.1378/chest.125.5.1622
  18. Skillington PD, Davies RH, Luff AJ, et al. Surgical treatment for infarct-related ventricular septal defects. Improved early results combined with analysis of late functional status. J Thorac Cardiovasc Surg 1990;99:798-808.
  19. Cannon CP, Brindis RG, Chaitman BR, et al. 2013 ACCF/ AHA key data elements and definitions for measuring the clinical management and outcomes of patients with acute coronary syndromes and coronary artery disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on clinical data standards (writing committee to develop acute coronary syndromes and coronary artery disease clinical data standards). J Am Coll Cardiol 2013;61:992-1025. https://doi.org/10.1016/j.jacc.2012.10.005
  20. Anderson DR, Adams S, Bhat A, Pepper JR. Post-infarction ventricular septal defect: the importance of site of infarction and cardiogenic shock on outcome. Eur J Cardiothorac Surg 1989;3:554-7. https://doi.org/10.1016/1010-7940(89)90118-8

Cited by

  1. ECMO and Cytokine Removal for Bridging to Surgery in a Patient with Ischemic Ventricular Septal Defect - a Case Report vol.40, pp.9, 2017, https://doi.org/10.5301/ijao.5000600
  2. Management Issues During Postinfarction Ventricular Septal Defect and Role of Perioperative Optimization: A Case Series vol.22, pp.1, 2013, https://doi.org/10.4103/aca.aca_189_17
  3. Longitudinal Outcomes After Surgical Repair of Postinfarction Ventricular Septal Defect in the Medicare Population vol.109, pp.4, 2020, https://doi.org/10.1016/j.athoracsur.2019.08.024
  4. Surgical Repair of Postinfarction Ventricular Septal Rupture: Systematic Review and Meta-Analysis vol.112, pp.1, 2013, https://doi.org/10.1016/j.athoracsur.2020.08.050