Long-term Results after Primary Surgical Repair of Post-infraction Ventricular Septal Defects: A Retrospective Single Centre Experience

Background: Postinfarction ventricular septal defect (pVSD) complicating acute myocardial infarction (AMI) still carries a high mortality. The aim of this single center study was to detect predictors for early and long-term outcome in patients undergoing primary surgical repair of pVSD managed by various surgical techniques.

Methods: Between October 1994 and April 2014, 77 consecutive patients (male= 45; mean age= 68.7 ± 9.42 years; logEuroSCORE= 42.4 ± 25.8%) underwent primary surgical repair after pVSD. Anterior pVSD was present in 45 patients (58.4%), and posterior pVSD in 32 (41.6%). Buttressed mattress suture (n = 9, 11.7%), simple single septal patch (n = 34, 44.2%), simple double septal patch (n = 2, 2.6%), sandwich double patch (n = 1, 1.3%), and infarct exclusion by David (n = 31, 40.3%) were performed for surgical closure. Prospectively collected demographic and peri-operative data were analyzed retrospectively. Predictors of 30-day-mortality (30dm) and long-term outcome were calculated.

Results: The 30-day mortality (30dm) was 42.8% (33 patients). There was no statistical difference for 30dm between infarct exclusion by David compared with the other surgical closure techniques. Univariate predictors of 30dm were emergency surgery (p< 0.001), pre-operative cardiogenic shock (CS) (p = 0.001), duration between AMI to surgery less than 7 days (p< 0.001), pre-operative need of inotropics (p = 0.039), and pre-operative absence of Beta-blockers (p = 0.038) and ACE-inhibitors (p = 0.039). Independent risk factors of 30dm were duration between AMI to surgery less than 7 days (OR 7.95, CI 2.49–25.40; p≤ 0.001), and pre-OP CS (OR 4.22, CI 1.39–12.79; p = 0.011). Cumulative survival rates at 1, 5 and 10 years were 57.1, 57.1 and 31.2% respectively.

Conclusion: 30-day mortality of pVSD remains high. Pre-operative CS influences mortality significantly. Early implantation of extracorporeal assist devices to prevent cardiogenic shock may improve the surgical outcome.