Surgical repair of postinfarction ventricular septal rupture: 27 years of single institution experience

Objectives: Postinfarction ventricular septal rupture is a serious complication associated with high hospital mortality. The objective of this study is to identify predictors of early and late outcome in patients with postinfarction ventricular septal defect during a 27-year period.

Methods: Between September 1982 and December 2009, a consecutive series of 48 patients (23 men, mean age 66.5 ± 10.3 years) who underwent surgical repair of postinfarction ventricular septal rupture in our department was studied. A retrospective analysis of clinical and operative data, predictors of early mortality and long-term survival was performed. Follow-up was 100% complete.

Results: Thirty-day mortality was 39% (19 patients). Follow-up of 30-day survivors was mean 8.3 ± 7.7 years and a median of 5.5 years. Actuarial survival of 30-day survivors was 90% at 1 year, 70% at 5 years, 28% at 10 years and 24% at 15 years. Age, female gender, renal insufficience, shock at surgery, urgent operation, three-vessel disease, imcomplete revascularization and cardiopulmonary bypass time were univariate predictors of 30-day mortality, whereas multithree-vessel disease, concomitant coronary artery bypass grafting and imcomplete coronary revascularization were independent risk factors of 30-day mortality by means of multivariable analysis. Concomitant coronary artery bypass grafting at repair of ventricular septal rupture did not significantly affect long-term mortality (Log rank P = 0.079).

Conclusion: Early mortality after surgical repair of postinfarction septal rupture still remains poor in our series. In patients with ventricular septal rupture, improvement of shock status preoperatively and aggressive coronary revascularization is mandatory.