PMID- 23497648
OWN - NLM
STAT- MEDLINE
DCOM- 20130819
LR  - 20220331
IS  - 1749-8090 (Electronic)
IS  - 1749-8090 (Linking)
VI  - 8
DP  - 2013 Mar 9
TI  - Outcome and survival analysis of surgical repair of post-infarction ventricular 
      septal rupture.
PG  - 44
LID - 10.1186/1749-8090-8-44 [doi]
AB  - 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.
FAU - Pang, Philip Y K
AU  - Pang PY
AD  - Department of Cardiothoracic Surgery National Heart Centre, Mistri Wing 17 Third 
      Hospital Avenue, Singapore 168752, Singapore. philip.pang.y.k@nhcs.com.sg
FAU - Sin, Yoong Kong
AU  - Sin YK
FAU - Lim, Chong Hee
AU  - Lim CH
FAU - Tan, Teing Ee
AU  - Tan TE
FAU - Lim, See Lim
AU  - Lim SL
FAU - Chao, Victor T T
AU  - Chao VT
FAU - Su, Jang Wen
AU  - Su JW
FAU - Chua, Yeow Leng
AU  - Chua YL
LA  - eng
PT  - Journal Article
DEP - 20130309
PL  - England
TA  - J Cardiothorac Surg
JT  - Journal of cardiothoracic surgery
JID - 101265113
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Analysis of Variance
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*surgery
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Survival Analysis
MH  - Treatment Outcome
MH  - Ventricular Septal Rupture/*surgery
PMC - PMC3599964
EDAT- 2013/03/19 06:00
MHDA- 2013/08/21 06:00
PMCR- 2013/03/09
CRDT- 2013/03/19 06:00
PHST- 2013/01/13 00:00 [received]
PHST- 2013/03/06 00:00 [accepted]
PHST- 2013/03/19 06:00 [entrez]
PHST- 2013/03/19 06:00 [pubmed]
PHST- 2013/08/21 06:00 [medline]
PHST- 2013/03/09 00:00 [pmc-release]
AID - 1749-8090-8-44 [pii]
AID - 10.1186/1749-8090-8-44 [doi]
PST - epublish
SO  - J Cardiothorac Surg. 2013 Mar 9;8:44. doi: 10.1186/1749-8090-8-44.