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KMID : 0364020130460060433
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Korean Journal of Thoracic and Cardiovascular Surgery
2013 Volume.46 No. 6 p.433 ~ p.438
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Surgical Repair of Ventricular Septal Defect after Myocardial Infarction: A Single Center Experience during 22 Years
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Park Sung-Jung
Kim Joon-Bum
Jung Sung-Ho
Choo Suk-Jung
Chung Cheol-Hyun
Lee Jae-Won
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Abstract
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Background : Surgical repair of post-infarct ventricular septal defect (VSD) is considered one of the most challenging procedures having high surgical mortality. This study aimed to evaluate the outcomes of the surgical repair of post-infarct VSD.
Methods : From May 1991 to July 2012, 34 patients (mean age, 67.1±7.9 years) underwent surgical repair of post-infarct VSD. A retrospective review of clinical and surgical data was performed.
Results : VSD repair involved the infarct exclusion technique using a patch in all patients. For coronary revascularization, 12 patients (35.3%) underwent concomitant coronary artery bypass graft, 3 patients (8.8%) underwent preoperative percutaneous coronary intervention, and 9 patients (26.5%) underwent both of these procedures. The early mortality rate was 20.6%. Six patients (17.6%) required reoperation due to residual shunt or newly developed VSD. During follow-up (median, 4.8 years; range, 0 to 18.4 years), late death occurred in nine patients. Overall, the 5-year and 10-year survival rates were 54.4%±8.8% and 44.3%±8.9%, respectively. According to a Cox regression analysis, preoperative cardiogenic shock (p=0.069) and prolonged cardiopulmonary bypass time (p=0.008) were independent predictors of mortality.
Conclusion : The early surgical outcome of post-infarct VSD was acceptable considering the high-risk nature of the disease. The long-term outcome, however, was still dismal, necessitating comprehensive optimal management through close follow-up.
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KEYWORD
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Myocardial infarction, Ventricular heart septal defects, Surgery, Mortality, Risk factors
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