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Title: Outcome and survival analysis of surgical repair of post-infarction ventricular septal rupture
Authors: Pang, P.Y.K
Sin, Y.K 
Lim, C.H
Tan, T.E 
Lim, S.L 
Chao, V.T.T 
Su, J.W
Chua, Y.L 
Keywords: aged
analysis of variance
heart infarction
heart ventricle septum rupture
middle aged
retrospective study
risk factor
treatment outcome
very elderly
Aged, 80 and over
Analysis of Variance
Middle Aged
Myocardial Infarction
Retrospective Studies
Risk Factors
Survival Analysis
Treatment Outcome
Ventricular Septal Rupture
Issue Date: 2013
Citation: Pang, P.Y.K, Sin, Y.K, Lim, C.H, Tan, T.E, Lim, S.L, Chao, V.T.T, Su, J.W, Chua, Y.L (2013). Outcome and survival analysis of surgical repair of post-infarction ventricular septal rupture. Journal of Cardiothoracic Surgery 8 (1) : 44. ScholarBank@NUS Repository.
Rights: Attribution 4.0 International
Abstract: Background: To review the experience of surgical repair of post-infarction ventricular septal rupture (VSR) and analyze the associated outcomes and prognostic factors. Methods: Following approval from the Singhealth Centralised Institutional Review Board (reference: 2011/881/C), a retrospective review was performed on 38 consecutive patients who had undergone surgical repair of post-infarction VSR between 1999 and 2011. Continuous variables were expressed as either mean ± standard deviation or median with 25th and 75th percentiles. These were compared using two-tailed t-test or Mann-Whitney U test respectively. Categorical variables were compared using chi-square or Fisher's exact test. To identify predictors of operative mortality, univariate analysis of perioperative variables followed by multivariate analysis of significant univariate risk factors was performed. A two-tailed p-value < 0.05 was used to indicate statistical significance. Results: Mean age was 65.7 ± 9.4 years with 52.6% males. The VSR was anterior in 28 (73.7%) and posterior in 10 patients. Median interval from myocardial infarction to VSR was 1 day (1, 4). Pre-operative intra-aortic balloon pump was inserted in 37 patients (97.8%). Thirty-six patients (94.7%) underwent coronary angiography. Thirty-five patients (92.1%) underwent patch repair. Mean aortic cross clamp time was 82 ± 40 minutes and mean cardiopulmonary bypass time was 152 ± 52 minutes. Coronary artery bypass grafting (CABG) was performed in 19 patients (50%), with a mean of 1.5 ± 0.7 distal anastomoses. Operative mortality within 30 days was 39.5%. Univariate analysis identified emergency surgery, New York Heart Association (NYHA) class, inotropic support, right ventricular dysfunction, EuroSCORE II, intra-operative red cell transfusion, post-operative renal failure and renal replacement therapy (RRT) as predictors of operative mortality. Multivariate analysis identified NYHA class and post-operative RRT as predictors of operative mortality. Ten year overall survival was 44.4 ± 8.4%. Right ventricular dysfunction, LVEF and NYHA class at presentation were independent factors affecting long-term survival. Concomitant CABG did not influence early or late survival. Conclusions: Surgical repair of post-infarction VSR carries a high operative mortality. NYHA class at presentation and post-operative RRT are predictors of early mortality. Right ventricular dysfunction, LVEF and NYHA class at presentation affect long-term survival. Concomitant CABG does not improve survival. © 2013 Pang et al; licensee BioMed Central Ltd.
Source Title: Journal of Cardiothoracic Surgery
ISSN: 17498090
DOI: 10.1186/1749-8090-8-44
Rights: Attribution 4.0 International
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