Clinical Outcomes for Postinfarct Ventricular Septal Defect Repair in a Large State-Wide Surgical Registry

Mohamad B Moumneh; Mohammed A Quader; Nicholas R Teman; Daniel Tang; Liam Ryan; Raymond J Strobel; Mark Joseph; Michael Mazzeffi; Zachary M Gertz; Michael C Kontos; Ramesh Singh; Alan Spier; Eric Sarin; Abdulla A Damluji

doi:10.1016/j.amjcard.2024.12.028

Clinical Outcomes for Postinfarct Ventricular Septal Defect Repair in a Large State-Wide Surgical Registry

Am J Cardiol. 2024 Dec 30:240:64-67. doi: 10.1016/j.amjcard.2024.12.028. Online ahead of print.

Authors

Affiliations

¹ Inova Center of Outcomes Research, Inova Heart and Vascular, Fairfax, Virginia.
² Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia.
³ Department of Surgery, University of Virginia, Charlottesville, Virginia.
⁴ Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
⁵ Division of Cardiothoracic Surgery, Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia.
⁶ Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, Virginia.
⁷ Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
⁸ Inova Center of Outcomes Research, Inova Heart and Vascular, Fairfax, Virginia. Electronic address: Abdulla.Damluji@inova.org.

PMID: 39743025
DOI: 10.1016/j.amjcard.2024.12.028

Abstract

Ventricular septal defect (VSD) is a life-threatening complication occurring after delayed presentation of acute myocardial infarction (AMI). We assessed clinical characteristics based on mortality following surgical repair of post-AMI VSD and evaluated trends of mortality, mechanical circulatory support (MCS) device use, and surgical approach. We included all patients who had surgical VSD repair following AMI who were included in a regional quality collaborative from May 2008 through January 2020. The primary outcome was in-hospital mortality. A univariate logistic regression model was utilized for each clinical variable on in-hospital mortality, while a multivariable model was used on age and variables that showed significant association (p <0.05) in the univariable model. Of the 79 patients who received repair, 32 (41%) were ≥70 years, 49 (62%) were male, and 28 (35%) died. The preoperative mean ejection fraction was 35%. Cardiogenic shock (CS) was observed in 53% (alive vs dead: 39% vs 79%, p = 0.001), while 6% required cardiopulmonary resuscitation (alive vs dead: 2% vs 14%, p = 0.05). MCS devices including extracorporeal membrane oxygenation were used in 22% (alive vs dead: 4% vs 54%, p <0.001). Emergent surgery was performed in 37% (alive vs dead: 18% vs 71%, p <0.001), concomitant aortic valve replacement in 10% (alive vs dead: 11% vs 9%, p = 0.029), and delayed intervention (beyond 7 days) in 44% (alive vs dead: 57% vs 21%, p = 0.002). Intraoperatively, blood products were used in 49% (alive vs dead: 45% vs 57%, p = 0.005). Following repair, 22% suffered from renal failure (alive vs dead: 19% vs 48%, p = 0.021). Patients who experienced delayed intervention had higher survival rates probably related to survival bias. Patients who suffered in-hospital mortality were more likely to have CS and to require MCS. Improvement in patient selection by a "Heart Team" approach and new therapeutic options are needed as part of advanced care for mechanical complications of AMI.

Keywords: acute; aging; heart rupture; heart septal defects; myocardial infarction; reperfusion; ventricular.