Outcome of Postinfarction Ventricular Septal Defect Repair in the Era of Mechanical Circulatory Support

Objectives: Postinfarction ventricular septal defect (VSD) is a rare but life threatening complication of acute myocardial infarction (AMI). The outcome of VSD remains poor even in the era of reperfusion therapy. Objective guidelines for proper management of this entity are still not available. We present our center’s experience with surgical repair of postinfarction VSD and analyzed outcomes to identify prognostic factors.

Methods: From August 2002 to September 2019, data from 32 consecutive patients (mean age, 69 ± 10.2 years) with postinfarction VSD who underwent surgical repair at our institute were retrospectively reviewed. Univariate and multivariate analysis was subsequently carried out by constructing a logistic regression model in order to identify independent predictors of postoperative mortality.

Results: Percutaneous coronary intervention was performed in 19 (59.4%) patients, intra-aortic balloon pump (IABP) was used in 14 (43.8%), two (6.3%) were supported with extracorporeal life support (ECLS) and one (3.1%) was supported with IMPELLA preoperatively. Concomitant coronary artery bypass grafting was performed in 15 (46.9%) patients. Mortality rate was 53.3% (16 of 33). The survival rate was 41.18% with preoperative mechanical circulatory support (MCS) and 58.82% without. Age was no significantly different between survivors and nonsurvivors (67.1 ± 9.1 vs. 71.9  ± 10.9 years, p = 0.09). Univariate analysis revealed that the survivors had lower European system for cardiac operative risk evaluation II (EuroSCORE II) (11.46% ± 6.0 vs. 19.13% ± 11.98, p = 0.01). Concomitant artery bypass grafting (p = 0.17) and location of VSD (p = 0.28) did not affect the outcome.

Conclusion: Postinfarction VSD remains a serious and challenging complication of AMI in the modern surgical era. The EuroSCORE II can be used for an approximate prediction of operative mortality. The role and timing of MCS in the treatment of postinfarction VSD are not well understood. Further studies are needed to evaluate its impact.