Urgent surgical repair of postinfarction ventricular septal rupture: early and late outcome.

AIM: This retrospective analysis focuses on predictive factors of operative mortality and long-term survival after surgical repair of postinfarction ventricular septal rupture (VSR).

METHODS

Sixty-seven patients (43 males, 24 females) with VSR underwent surgical repair between December 1977 and December 1995. The site of the rupture was anterior in 44 patients and posterior in 23. The mean interval between myocardial infarction (MI) and VSR was 3.6+/-4.1 days. Clinical condition on admission was critical in 63 patients (49 in cardiogenic shock). An intra-aortic balloon pump was inserted preoperatively in 54 patients.

RESULTS

Operative mortality was 25% (17 patients). The main cause of death was cardiac failure. Factors influencing early deaths in univariate analysis were preoperative hemodynamic status (cardiogenic shock present in 30%; absent in 8%; p = 0.001), the location of the MI (anterior in 11.6%, posterior in 45.4%), the interval between infarction and surgery (<1 week was 33%, >1 week was 6.2%), and the response to initial active therapy. All patients were available for follow-up. The actuarial survival rates at 1 and 5 years are 74.6%+/-5.3% and 66.2%+/-6.2%, respectively. There were 12 late deaths and 40% were cardiac related. Two patients presented residual VSD (one reoperation). The left ventricular ejection fraction (LVEF) was mildly impaired in 9 patients. Three patients had moderate mitral insufficiency and two had moderate tricuspid insufficiency.

CONCLUSION

Repair of the postinfarction VSR remains a challenge. Improvement should be rendered possible by optimizing techniques. Postoperative morbidity is high, and these patients require intensive hospital resources. The late results have been satisfactory.