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  • Title: Survival after surgical repair of ischemic ventricular septal rupture.
    Author: Abu-Omar Y, Bhinda P, Choong CK, Nashef SA, Nair S.
    Journal: Asian Cardiovasc Thorac Ann; 2012 Aug; 20(4):404-8. PubMed ID: 22879546.
    Abstract:
    OBJECTIVES: We reviewed our results and experience over a 14-year period to identify predictors of outcome following surgical repair of postinfarction ventricular septal rupture. METHODS: A retrospective review was carried over a 14-year period. All patients had surgical repair of a postinfarction ventricular septal rupture. Patient demographics, perioperative variables, and survival data were collected. Logistic regression identified independent predictors of 30-day mortality. Multivariate analysis determined the effects of independent risk factors on survival. RESULTS: Surgery for postinfarction ventricular septal rupture was carried out on 59 patients. The median age was 69 years, and 69% were male. In 54% of patients, the ventricular septal rupture was anterior, and 75% had concomitant coronary artery bypass grafting. Mortality was 39% at 30 days. Age was the most important predictor of 30-day and long-term outcome. Logistic regression analysis identified age, preoperative ventilation, and female sex as significant predictors of 30-day mortality. Cardiogenic shock, preoperative ventilation, and advanced age were associated with reduced medium-term survival. Surprisingly, anterior ventricular septal rupture was associated with reduced long-term survival. Concomitant coronary artery bypass grafting did not influence 30-day or long-term outcome. CONCLUSIONS: Despite advances, the surgical mortality from ventricular septal rupture remains high. Age remains the most important predictor of outcome, and concomitant coronary artery bypass grafting does not appear to have a demonstrable benefit. Interestingly, anterior ventricular septal rupture had poorer long-term outcome than inferior ventricular septal rupture.
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