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Treatment Strategies for Ventricular Septal Rupture After Myocardial Infarction: A Single-Center Experience

OBJECTIVE: To analyze treatment strategies, prognosis, and related risk factors of patients with postinfarction ventricular septal rupture, as well as the impact of timing of surgical intervention. METHODS: A total of 23 patients diagnosed with postinfarction ventricular septal rupture who were non-...

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Autores principales: Ma, Dongliang, Zhang, Zhibiao, Zhang, Shunye, Wang, Zhongchao, Zhang, Gang, Wang, Chongjun, Xi, Jicheng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8899464/
https://www.ncbi.nlm.nih.gov/pubmed/35265690
http://dx.doi.org/10.3389/fcvm.2022.843625
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author Ma, Dongliang
Zhang, Zhibiao
Zhang, Shunye
Wang, Zhongchao
Zhang, Gang
Wang, Chongjun
Xi, Jicheng
author_facet Ma, Dongliang
Zhang, Zhibiao
Zhang, Shunye
Wang, Zhongchao
Zhang, Gang
Wang, Chongjun
Xi, Jicheng
author_sort Ma, Dongliang
collection PubMed
description OBJECTIVE: To analyze treatment strategies, prognosis, and related risk factors of patients with postinfarction ventricular septal rupture, as well as the impact of timing of surgical intervention. METHODS: A total of 23 patients diagnosed with postinfarction ventricular septal rupture who were non-selectively admitted to Shanxi Provincial Cardiovascular Hospital between October 2017 and August 2021 were included in this study. The relevant clinical data, operation-related conditions, and follow-up data were summarized for all patients. The Kaplan-Meier method and log-rank test were used for the cumulative incidence of unadjusted mortality in patients with different treatment methods. Multivariate logistic regression was used to evaluate the independent risk factors for in-hospital patient mortality. RESULTS: The mean age of the study patients was 64.43 ± 7.54 years, 12(52.2%) were females. There was a significant difference in terms of postoperative residual shunt between the surgical and interventional closure groups (5.9 vs. 100%, respectively; P < 0.001). The overall in-hospital mortality rate was 21.7%; however, even though the surgical group had a lower mortality rate than the interventional closure group (17.6 vs. 33%, respectively), this difference was not statistically significant (P = 0.576). Univariate analysis showed that in-hospital survival group patients were significantly younger than in-hospital death group patients (62.50 ± 6.53 vs. 71.40 ± 7.37 years, respectively; P = 0.016), and that women had a significantly higher in-hospital mortality rate than men (P = 0.037). The average postoperative follow-up time was 18.11 ± 13.92 months; as of the end of the study all 14 patients in the surgical group were alive, Two out of four patients survived and two patients died after interventional closure. Univariate analysis showed that interventional closure was a risk factor for long-term death (P < 0.05). CONCLUSION: Surgical operation is the most effective treatment for patients with postinfarction ventricular septal rupture; however, the best timing of the operation should be based on the patient's condition and comprehensively determined through real-time evaluation and monitoring. We believe that delaying the operation time as much as possible when the patient's condition permits can reduce postoperative mortality. Interventional closure can be used as a supplementary or bridge treatment for surgical procedures.
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spelling pubmed-88994642022-03-08 Treatment Strategies for Ventricular Septal Rupture After Myocardial Infarction: A Single-Center Experience Ma, Dongliang Zhang, Zhibiao Zhang, Shunye Wang, Zhongchao Zhang, Gang Wang, Chongjun Xi, Jicheng Front Cardiovasc Med Cardiovascular Medicine OBJECTIVE: To analyze treatment strategies, prognosis, and related risk factors of patients with postinfarction ventricular septal rupture, as well as the impact of timing of surgical intervention. METHODS: A total of 23 patients diagnosed with postinfarction ventricular septal rupture who were non-selectively admitted to Shanxi Provincial Cardiovascular Hospital between October 2017 and August 2021 were included in this study. The relevant clinical data, operation-related conditions, and follow-up data were summarized for all patients. The Kaplan-Meier method and log-rank test were used for the cumulative incidence of unadjusted mortality in patients with different treatment methods. Multivariate logistic regression was used to evaluate the independent risk factors for in-hospital patient mortality. RESULTS: The mean age of the study patients was 64.43 ± 7.54 years, 12(52.2%) were females. There was a significant difference in terms of postoperative residual shunt between the surgical and interventional closure groups (5.9 vs. 100%, respectively; P < 0.001). The overall in-hospital mortality rate was 21.7%; however, even though the surgical group had a lower mortality rate than the interventional closure group (17.6 vs. 33%, respectively), this difference was not statistically significant (P = 0.576). Univariate analysis showed that in-hospital survival group patients were significantly younger than in-hospital death group patients (62.50 ± 6.53 vs. 71.40 ± 7.37 years, respectively; P = 0.016), and that women had a significantly higher in-hospital mortality rate than men (P = 0.037). The average postoperative follow-up time was 18.11 ± 13.92 months; as of the end of the study all 14 patients in the surgical group were alive, Two out of four patients survived and two patients died after interventional closure. Univariate analysis showed that interventional closure was a risk factor for long-term death (P < 0.05). CONCLUSION: Surgical operation is the most effective treatment for patients with postinfarction ventricular septal rupture; however, the best timing of the operation should be based on the patient's condition and comprehensively determined through real-time evaluation and monitoring. We believe that delaying the operation time as much as possible when the patient's condition permits can reduce postoperative mortality. Interventional closure can be used as a supplementary or bridge treatment for surgical procedures. Frontiers Media S.A. 2022-02-22 /pmc/articles/PMC8899464/ /pubmed/35265690 http://dx.doi.org/10.3389/fcvm.2022.843625 Text en Copyright © 2022 Ma, Zhang, Zhang, Wang, Zhang, Wang and Xi. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Ma, Dongliang
Zhang, Zhibiao
Zhang, Shunye
Wang, Zhongchao
Zhang, Gang
Wang, Chongjun
Xi, Jicheng
Treatment Strategies for Ventricular Septal Rupture After Myocardial Infarction: A Single-Center Experience
title Treatment Strategies for Ventricular Septal Rupture After Myocardial Infarction: A Single-Center Experience
title_full Treatment Strategies for Ventricular Septal Rupture After Myocardial Infarction: A Single-Center Experience
title_fullStr Treatment Strategies for Ventricular Septal Rupture After Myocardial Infarction: A Single-Center Experience
title_full_unstemmed Treatment Strategies for Ventricular Septal Rupture After Myocardial Infarction: A Single-Center Experience
title_short Treatment Strategies for Ventricular Septal Rupture After Myocardial Infarction: A Single-Center Experience
title_sort treatment strategies for ventricular septal rupture after myocardial infarction: a single-center experience
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8899464/
https://www.ncbi.nlm.nih.gov/pubmed/35265690
http://dx.doi.org/10.3389/fcvm.2022.843625
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