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Cardiothoracic Surgery |

Surgical Repair of Postinfarction Ventricular Septal Rupture - 12 Years of Experience in an Asian Population

Philip Yi Kit Pang*, MBBS; Yoong Kong Sin, MBBS; Chong Hee Lim, MBBS; Yeong Phang Lim, MBBS; Jang Wen Su, MBBS; Yeow Leng Chua, MBBS
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National Heart Centre, Singapore, Singapore, Singapore


Chest. 2012;142(4_MeetingAbstracts):75A. doi:10.1378/chest.1364999
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Abstract

SESSION TYPE: Cardiac Surgery Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: To review our experience of surgical repair of post-infarction ventricular septal rupture (VSR) and analyse the outcomes and prognostic factors associated with this condition.

METHODS: In a retrospective review from January 1999 to December 2011, 38 patients underwent VSR repair at our tertiary referral centre.

RESULTS: Mean age was 65.7 ± 9.4 years (45 - 83). Male patients accounted for 52.6% of cases. The VSR location was anterior in 28 patients (73.7%) and posterior in 10 patients (26.3%). The median interval between myocardial infarction and septal rupture was 1 day (1, 4). Pre-operative intra-aortic balloon pump (IABP) counter-pulsation was used in 37 patients (97.8%). Coronary angiography was performed in 36 patients (94.7%). A patch repair technique was used in 35 patients (92.1%). Median aortic cross clamp time was 79 minutes (62.8, 108.0). Coronary artery bypass grafting (CABG) was performed in 19 patients (50%), with a mean of 1.5 ± 0.7 distal anastomoses. Operative mortality within 30 days of surgery was 39.5%, 32.1% in anterior and 60.0% in posterior septal ruptures. Univariate analysis identified emergency operation, New York Heart Association (NYHA) class, inotropic support, right ventricular dysfunction, intra-operative red blood cell transfusion, post-operative renal failure and renal replacement therapy (RRT) as predictors of operative mortality. Logistic multivariate analysis identified NYHA class and post-operative RRT as independent predictors of operative mortality. Five year survival was 44.4%. Right ventricular dysfunction, left ventricular ejection fraction (LVEF) and NYHA class were independent factors affecting long-term survival. Concomitant CABG during VSR repair did not significantly affect survival.

CONCLUSIONS: Surgical repair of post-infarction VSR carries a high operative mortality. NYHA class at presentation and post-operative RRT are predictors of early mortality. Right ventricular dysfunction, LVEF and NYHA class are independent factors influencing long-term survival. Concomitant CABG during VSR repair did not significantly improve survival.

CLINICAL IMPLICATIONS: These factors identified may aid in prognostication of patients undergoing surgical repair of VSR. The benefit of concomitant CABG during VSR repair remains uncertain.

DISCLOSURE: The following authors have nothing to disclose: Philip Yi Kit Pang, Yoong Kong Sin, Chong Hee Lim, Yeong Phang Lim, Jang Wen Su, Yeow Leng Chua

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National Heart Centre, Singapore, Singapore, Singapore

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