Early and late mortality and morbidity after post-MI ventricular septal rupture repair: predictors, strategies, and results
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There has been a shift in the paradigm of management of post-myocardial infarction ventricular septal rupture (MI VSR), with many authors reporting improved prognosis if the surgery can be “optimally delayed.” Timing of the procedure is of critical importance and our management (UPMS), and prognosis scores (UPPS) have proven to be relevant. However, long-term outcomes and their correlation with our scores had not been analyzed. In this study, we present our long-term results of post-MI-VSR repair and their correlation with our prognosis score (UPPS).
Seventy-one patients with post-MI VSR repair (2009–2017) were retrospectively studied. Patients were managed using standard institute protocols.
The 30-day mortality was 56% (n = 40). During a mean follow-up of 4.91 ± 2.43 years, there were eight late deaths. Actuarial survival of 30-day survivors was 87% at 1 year, 74% at 5 years, and 69% at 10 years. Actuarial freedom from major adverse cardiovascular events (MACE) was 82% at 1 year, 72% at 2 years, and 72% at 8 years. The UPPS score predicts late mortality with sensitivity of 75% and negative predictive value of 84%.
Our prognostic score (UPPS) helps not only in predicting early mortality but also in identifying the patients who are likely to live longer. The management score (UPMS) also provides best timing for the procedure, which is helpful in optimal utilization of resources in the developing world. The accuracy of these scores is reasonable and may be helpful in the decision-making in this difficult subset.
KeywordsMyocardial infarction Ventricular septal rupture Extracorporeal membrane oxygenation
This work was supported by U.N. Mehta Institute of Cardiology and Research Center itself and received no specific grant from any funding agency, commercial, or not-for-profit sectors.
Compliance with ethical standards
Conflict of interest
The authors declare that there is no conflict of interest.
This study does not involve the use of any animal. Also, in the case of patients, all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent has been taken from patients, and none has been forced to be a part of study.
- 5.Malhotra A, Patel K, Sharma P, et al. Techniques, timing & prognosis of post infarct ventricular deptal repair: a re-look at old dogmas. Braz J Cardiovasc Surg. 2017;32:147–55.Google Scholar
- 7.Cooley DA, Belmonte BA, Zeis LB, Schnur S. Surgical repair of ruptured interventricular septum following acute myocardial infarction. Surgery. 1957;41:930–7.Google Scholar