EARLY MORTALITY AFTER SURGICAL REPAIR OF POSTINFARCTION VENTRICULAR SEPTAL RUPTURE - IMPORTANCE OF RUPTURE LOCATION

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.