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Outcome and survival analysis of surgical repair of post-infarction ventricular septal rupture

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 revi...

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Autores principales: Pang, Philip YK, Sin, Yoong Kong, Lim, Chong Hee, Tan, Teing Ee, Lim, See Lim, Chao, Victor TT, Su, Jang Wen, Chua, Yeow Leng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3599964/
https://www.ncbi.nlm.nih.gov/pubmed/23497648
http://dx.doi.org/10.1186/1749-8090-8-44
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author Pang, Philip YK
Sin, Yoong Kong
Lim, Chong Hee
Tan, Teing Ee
Lim, See Lim
Chao, Victor TT
Su, Jang Wen
Chua, Yeow Leng
author_facet Pang, Philip YK
Sin, Yoong Kong
Lim, Chong Hee
Tan, Teing Ee
Lim, See Lim
Chao, Victor TT
Su, Jang Wen
Chua, Yeow Leng
author_sort Pang, Philip YK
collection PubMed
description 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 25(th) and 75(th) 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.
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spelling pubmed-35999642013-03-17 Outcome and survival analysis of surgical repair of post-infarction ventricular septal rupture Pang, Philip YK Sin, Yoong Kong Lim, Chong Hee Tan, Teing Ee Lim, See Lim Chao, Victor TT Su, Jang Wen Chua, Yeow Leng J Cardiothorac Surg Research Article 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 25(th) and 75(th) 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. BioMed Central 2013-03-09 /pmc/articles/PMC3599964/ /pubmed/23497648 http://dx.doi.org/10.1186/1749-8090-8-44 Text en Copyright ©2013 Pang et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Pang, Philip YK
Sin, Yoong Kong
Lim, Chong Hee
Tan, Teing Ee
Lim, See Lim
Chao, Victor TT
Su, Jang Wen
Chua, Yeow Leng
Outcome and survival analysis of surgical repair of post-infarction ventricular septal rupture
title Outcome and survival analysis of surgical repair of post-infarction ventricular septal rupture
title_full Outcome and survival analysis of surgical repair of post-infarction ventricular septal rupture
title_fullStr Outcome and survival analysis of surgical repair of post-infarction ventricular septal rupture
title_full_unstemmed Outcome and survival analysis of surgical repair of post-infarction ventricular septal rupture
title_short Outcome and survival analysis of surgical repair of post-infarction ventricular septal rupture
title_sort outcome and survival analysis of surgical repair of post-infarction ventricular septal rupture
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3599964/
https://www.ncbi.nlm.nih.gov/pubmed/23497648
http://dx.doi.org/10.1186/1749-8090-8-44
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