AI Article Synopsis
- Ventricular septal rupture (VSR) after a heart attack is a severe condition that requires surgery, and there is debate about the best time for this surgery and how to support patients leading up to it.
- A study analyzed 141 patients over a decade, finding that delaying surgery until at least 4 days after diagnosis significantly reduced mortality rates compared to surgery within the first 24 hours.
- The research also indicated that mechanical circulatory support (like IABP and VA-ECMO) was more commonly used in surgical patients, and overall, surgical intervention had a lower mortality rate (52.3%) compared to conservative treatment (91.5%).
Article Abstract
Background: Ventricular septal rupture (VSR) following acute myocardial infarction (AMI) is a dangerous condition. Surgical VSR closure is the definitive therapy, but there is controversy regarding the surgical timing and the bridging therapy between diagnosis and intervention. The objective of this study is to analyze the ideal time of surgical repair and to establish the contribution of mechanical circulatory support (MCS) devices on the prognosis.
Methods: We designed an observational, retrospective, multicenter study, selecting all consecutive patients with post-AMI VSR between January 1, 2008 and December 31, 2018, with non-exclusion criteria. The main objective of this study was to analyze the optimal timing for surgical repair of post-AMI VSR. Secondary endpoints were to determine which factors could influence mortality in the patients of the surgical group.
Results: A total of 141 patients were included. We identified lower mortality rates with an odds ratio of 0.3 (0.1-0.9) in patients operated on from day 4 compared with the surgical mortality in the first 24 hours after VSR diagnosis. The use of MCS was more frequent in patients treated with surgery, particularly for intra-aortic balloon pump (IABP; 79.6% vs. 37.8%, p < 0.001), but also for veno-arterial extracorporeal membrane oxygenation (VA-ECMO; 18.2% vs. 6.4%, p = 0.134). Total mortality was 91.5% for conservative management and 52.3% with surgical repair (p < 0.001).
Conclusions: In our study, we observed that the lowest mortality rates in patients with surgical repair of post-AMI VSR were observed in patients operated on from day 4 after diagnosis of VSR, compared to earlier interventions.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9550323 | PMC |
| http://dx.doi.org/10.5603/CJ.a2022.0035 | DOI Listing |
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