SHOULD CORONARY-ARTERY BYPASS-GRAFTING BE PERFORMED AT THE SAME TIME AS REPAIR OF A POST-INFARCT VENTRICULAR SEPTAL-DEFECT

Objective: The value of coronary artery bypass grafting (CABG) at the time of repair of a post-infarct ventricular septal defect (VSD) remai ns controversial. The aim of this study was to analyse the effect of C ABG on early mortality and survival following repair of an acquired VS D. Methods: Over 23 years, 179 patients, 118 male, 61 female, mean age 66 years (range 43-80), have undergone repair of a post-related VSD i n our unit. A total of 29 patients, who predominantly form the earlier part of the series. were operated on greater than I month after the i nfarct and are, therefore, excluded. Coronary angiography was performe d in 98 (65.3%) of the remaining 150 patients. Of these, 41 had corona ry artery disease (CAD) limited to the infarct-related vessel and 57 h ad additional significant CAD. Those with CAD limited to the infarct-r elated vessel were not grafted (Group A). Of those, 40 with significan t CAD underwent CABG at the time of VSD repair (Group B) and 17 did no t (Group C). In 52 patients the coronary anatomy was not documented (G roup D). Risk factors for early mortality were evaluated using logisti c regression. Actuarial survival was compared using log rank and Wilco xon tests. Cox's proportional hazards method was used to determine fac tors affecting survival. Results: Overall, 30 day mortality was 32%. C ABG did not significantly decrease operative mortality (logistic regre ssion). There was no statistically significant difference in early mor tality or actuarial survival between the four groups. CABG was not ass ociated with an increased survival (Cox's method). Conclusions: Concom itant CABG at the lime of VSD repair does not affect early mortality n or confer survival benefits. There seems to be no demonstrable benefit in revascularisation at the lime of repair and, therefore, it may be unnecessary to perform CABG or coronary angiography in these patients. (C) 1998 Elsevier Science B.V. All rights reserved.