Urgent surgical repair of postinfarction ventricular septal rupture: Earlyand late outcome

Aim: This retrospective analysis focuses on predictive factors of operative mortality and long-term survival after surgical repair of postinfarction v entricular septal rupture (VSR). Methods: Sixty-seven patients (43 males, 2 4 females) with VSR underwent surgical repair between December 1977 and Dec ember 1995. The site of the rupture was anterior in 44 patients and posteri or in 23. The mean interval between myocardial infarction (MI) and VSR was 3.6 +/- 4.1 days. clinical condition on admission was critical in 63 patien ts (49 in cardiogenic shock). An intra-aortic balloon pump was inserted pre operatively in 54 patients. Results: Operative mortality was 25% (17 patien ts). The main cause of death was cardiac failure. Factors influencing early deaths in univariate analysis were preoperative hemodynamic status (cardio genic shock present in 30%; absent in 8%; p = 0.001), the location of the M I (anterior in 11.6%, posterior in 45.4%), the interval between infarction and surgery (<1 week was 33%, >1 week was 6.2%), and the response to initia l active therapy. All patients were available for follow-up. The actuarial survival rates at 1 and 5 years are 74.6% +/- 5.3% and 66.2% +/- 6.2%, resp ectively. There were 12 late deaths and 40% were cardiac related. Two patie nts presented residual VSD (one reoperation). The left ventricular-ejection fraction (LVEF) was mildly impaired in 9 patients. Three patients had mode rate mitral insufficiency and two had moderate tricuspid insufficiency. Con clusion: Repair of the postinfarction VSR remains a challenge. Improvement should be rendered possible by optimizing techniques. Postoperative morbidi ty is high, and these patients require intensive hospital resources. The la te results have been satisfactory.