Protocol-based Surgical Intervention to Manage Ventricular Septal Rupture from a Tier Two City

INTRODUCTION: This study analyzes the outcome of a protocol-based surgical approach for ventricular septal rupture (VSR). The study also clarifies the appropriate time for intervention. METHODS: This is a single-center retrospective analysis of all VSR cases evaluated between February 2006 and March 2020. Cases were managed using the same protocol. Patients were divided into two cohorts - early (those in whom our protocol was instituted within 24 hours of diagnosis) and delayed (intervention between 24 hours and seven days after diagnosis). All-cause mortality was considered as the outcome. RESULTS: The mean age of presentation was 60.1 years, and 75.9% of the patients were men. Cardiogenic shock was the most common mode of presentation. Our analysis validates that once a patient develops VSR, age, sex, comorbidities, left ventricular function, and renal failure at the time of presentation do not have a statistically significant impact on the outcome. The sole factor to have an impact on the outcome was time of intervention. All patients in the delayed cohort expired after surgery, which dragged the overall mortality to 34.5%, whereas 95% of patients in the early cohort are still on follow-up. The mortality in this group was 5% (P≤0.001). CONCLUSION: Early surgical intervention has proven benefits over delayed approach. Surgical intervention in the early part of the disease reduces the risk and thus improves the outcome. The extreme rarity makes VSR an uncommon entity among surgeons. A protocol-based approach makes the team adapt to this unfamiliar situation better.