Korean J Thorac Cardiovasc Surg.  2013 Dec;46(6):433-438.

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

• Park SJ
• Kim JB
• Jung SH
• Choo SJ
• Chung CH
• Lee JW

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+/-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%+/-8.8% and 44.3%+/-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.

Keyword

Myocardial infarction; Ventricular heart septal defects; Surgery; Mortality; Risk factors

MeSH Terms

Cardiopulmonary Bypass
Coronary Artery Bypass
Follow-Up Studies
Heart Septal Defects, Ventricular*
Humans
Mortality
Myocardial Infarction*
Percutaneous Coronary Intervention
Reoperation
Retrospective Studies
Risk Factors
Shock, Cardiogenic
Survival Rate
Transplants