PMID- 10925229
OWN - NLM
STAT- MEDLINE
DCOM- 20001003
LR  - 20220331
IS  - 1010-7940 (Print)
IS  - 1010-7940 (Linking)
VI  - 18
IP  - 2
DP  - 2000 Aug
TI  - Post infarction ventricular septal defect - can we do better?
PG  - 194-201
AB  - OBJECTIVE: To identify predictors of early and late outcome among 117 consecutive 
      patients who underwent postinfarction ventricular septal defect (VSD) repair over 
      a period of 12 years. METHODS: A retrospective analysis of clinical data was 
      performed. Mean age was 65.5+/-7.8. There were 43 females. Full data were 
      obtained in 110 patients. Of these, 76 patients presented with anterior and 34 
      with posterior VSD. Thirty-three patients were operated in cardiogenic shock. 
      Mean time between myocardial infarction (MI) and VSD development was 5.6+/-7.8 
      days (median 4) and from VSD to surgery 9. 0+/-28.1 (median 2). Sixty-six 
      patients had intraaortic balloon pump (IABP) inserted, and 15 were ventilated 
      preoperatively. Logistic regression and Cox regression were used for multivariate 
      analysis. RESULTS: Thirty days mortality was 37%. Among 110 patients, in whom 
      complete analysis was possible, 38 died within 30 days (35%). Mortality in the 
      posterior VSD group was 35% and in the anterior VSD group 34% (NS). In 44 
      patients (40%) a residual shunt was found on postoperative echocardiography. This 
      required reoperation in 13 patients (four deaths). Cardiogenic shock prior to 
      surgery adversely influenced early survival - odds ratio (OR) 5.7 (confidence 
      interval (CI) 2.1-16.0) (P=0.0008). Deterioration of haemodynamic status in 
      between admission and surgery was stronger predictor of mortality than shock on 
      admission - OR 6.0 (CI 1.6-22.6) (P=0.008) vs. 3.1 (CI 1.0-9.3) (P=0.049). A 
      longer time between MI and surgery favoured survival - OR 0.1 (CI 0.03-0.4) 
      (P=0.002). The time period from the infarct to the septal rupture, but not from 
      the rupture to surgery, appeared to be a significant predictor of survival - OR 
      0.2 (CI 0. 05-0.6) (P=0.008). Five years survival was 46+/-5%. Preoperative 
      cardiogenic shock affected late survival - OR 2.7 (CI 1.5-4.9) (P=0. 001). Of 72 
      patients who survived 30 postoperative days, 12 (17%) were in New York Heart 
      Association (NYHA) class III or IV and five (6.9%) in Canadian Cardiovascular 
      Soceity (CCS) class III or IV at the last follow-up. CONCLUSIONS: Preoperative 
      cardiogenic shock and early postinfarction septal rupture carry a grave 
      prognosis. Achieving haemodynamic stability prior to surgery may be beneficial 
      but prolonged attempts to improve patients' cardiovascular state are hazardous.
FAU - Deja, M A
AU  - Deja MA
AD  - Department of Cardio-thoracic Surgery, Glenfield General Hospital, 1 Groby Road, 
      LE3 9QP, Leicester, UK. m.deja@btinternet.com
FAU - Szostek, J
AU  - Szostek J
FAU - Widenka, K
AU  - Widenka K
FAU - Szafron, B
AU  - Szafron B
FAU - Spyt, T J
AU  - Spyt TJ
FAU - Hickey, M S
AU  - Hickey MS
FAU - Sosnowski, A W
AU  - Sosnowski AW
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiac Surgical Procedures/methods
MH  - Echocardiography
MH  - Female
MH  - Heart Septal Defects, Ventricular/diagnostic imaging/*etiology/mortality/surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*complications/physiopathology
MH  - Odds Ratio
MH  - Prognosis
MH  - Retrospective Studies
MH  - Shock, Cardiogenic/etiology/mortality
MH  - Survival Rate
MH  - Ventricular Septal Rupture/diagnostic imaging/etiology/mortality/surgery
EDAT- 2000/08/05 11:00
MHDA- 2000/10/07 11:01
CRDT- 2000/08/05 11:00
PHST- 2000/08/05 11:00 [pubmed]
PHST- 2000/10/07 11:01 [medline]
PHST- 2000/08/05 11:00 [entrez]
AID - S1010-7940(00)00482-6 [pii]
AID - 10.1016/s1010-7940(00)00482-6 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2000 Aug;18(2):194-201. doi: 
      10.1016/s1010-7940(00)00482-6.