EARLY REPAIR OF POSTINFARCTION VENTRICULAR SEPTAL RUPTURE

Background. Postinfarction rupture of the interventricular septum is u sually fatal without surgical intervention. The optimal timing and the most appropriate technique of surgical repair remain unsettled. Metho ds. The results of surgical closure of postinfarction ventricular sept al defect in a consecutive series of patients seen over a 24-year peri od were reviewed and analyzed. Late follow-up was obtained in all pati ents who survived the operation. Results. Sixty of 76 patients treated surgically exhibited cardiogenic shock, low cardiac output syndrome, or both at the time of operation. A plan of early operative interventi on was followed in these unstable patients, with 60% of them undergoin g repair within 24 hours of septal rupture. For the entire series of p atients, the hospital mortality rate was 40.8%; survival was 41.5% at 5 years and 25.6% at 10 years postoperatively. Conclusions. Significan t trends observed during the period of study were a more aggressive st ance regarding surgical intervention in all patients who presented wit h hemodynamic instability and improved survival in those patients who presented with septal rupture complicating an inferior myocardial infa rction. (C) 1997 by The Society of Thoracic Surgeons