Surgical treatment of postinfarction ventricular septal defect: risk factors and outcome analysis

Objectives: Postinfarction ventricular septal defect is a serious mechanical complication of acute myocardial infarction associated with high postoperative mortality. The aim of this study was to review our experience with surgical repair of postinfarction ventricular septal defect and to identify predictors of early and late outcomes.

Methods: Thirty-nine patients (19 men and 20 women, mean age 68.4 ± 9.9 years) with postinfarction ventricular septal defect who underwent surgical repair at our institution between 1996 and 2016 were retrospectively evaluated. Risk factors were assessed by univariate analysis, with those found significant included in multivariate analysis.

Results: The ventricular septal defect was anterior in 21 (54%) patients and posterior in 18 (46%) patients. Mean aortic cross-clamp time was 91.8 ± 26.8 min, and mean cardiopulmonary bypass time was 146.3 ± 49.7 min. Twelve (31%) patients underwent concomitant coronary artery bypass grafting. The 30-day mortality rate was 36% (n = 14). The 30-day survival rate was higher with than without concomitant coronary artery bypass grafting (83% vs 56%), but concomitant coronary artery bypass grafting did not influence late survival (P = 0.098). Univariate analysis identified age, emergency surgery, inotropic support, Killip class, preoperative aspartate aminotransferase concentration, renal replacement therapy and ventricular septal defect diagnosis to operation interval as predictors of 30-day mortality. However, multivariate analysis showed that age and renal replacement therapy were the only independent risk factors of 30-day mortality.

Conclusions: Surgical repair of postinfarction ventricular septal defect has a high 30-day mortality rate. Higher age at presentation and postoperative renal replacement therapy are independent predictors of early mortality.