Ff. Cox et al., EARLY MORTALITY AFTER SURGICAL REPAIR OF POSTINFARCTION VENTRICULAR SEPTAL RUPTURE - IMPORTANCE OF RUPTURE LOCATION, The Annals of thoracic surgery, 61(6), 1996, pp. 1752-1757
Background. The aim of this study was to identify factors influencing
early outcome after surgical treatment of postinfarction ventricular s
eptal rupture. We investigated the influence of proximal or distal rup
ture location. Methods. Between 1980 and 1999 109 patients were treate
d surgically for ventricular septal rupture using a standardized techn
ique. A division in time periods was made. The rupture was categorized
according to its anterior or posterior site and proximal or distal lo
cation. Results. The 30-day mortality rate was 27.5%. Multivariate log
istic regression analysis identified preoperative shock (p = 0.0007) a
nd right atrial oxygen saturation less than 60% (p = 0.021) as predict
ors for early death; the risk for early death declined over the time p
eriods from 50% to 12.8% (p = 0.0007). Proximal ventricular septal rup
ture location (p = 0.0092) and interval between infarction and ventric
ular septal rupture less then 1 day (p = 0.034) were risk factors for
the occurrence of preoperative shock. Conclusions. Proximal ventricula
r septal rupture location was the main determinant of preoperative car
diogenic shock, which in turn was the strongest predictor of early mor
tality. Over the time periods a decrease in early mortality was reache
d.