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J Thorac Cardiovasc Surg 2009;137:862-868
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Surgical repair of postinfarction ventricular septal rupture: Risk factors of early and late death

Runar Lundblad, MD, PhDa,*, Michel Abdelnoor, PhDb, Odd R. Geiran, MD, PhDa,c, Jan L. Svennevig, MD, PhDa,c

a Department of Thoracic and Cardiovascular Surgery, Rikshospitalet, Oslo, Norway
b Research Forum, Unit of Clinical Epidemiology and Biostatistics, Ullevål University Hospital, Oslo, Norway
c Faculty Division, Rikshospitalet, University of Oslo, Oslo, Norway

Received for publication May 30, 2008; revisions received July 20, 2008; accepted for publication September 3, 2008.

* Address for reprints: Runar Lundblad, MD, PhD, Department of Thoracic and Cardiovascular Surgery, Rikshospitalet, N-0027 Oslo, Norway. (Email: rulund{at}rikshospitalet.no).

Objective: The aim of the study was to identify risk factors of early and late death after surgical repair of postinfarction ventricular septal rupture.

Methods: During a 25-year period, from May 1981 to August 2006, 102 patients underwent repair of postinfarction ventricular septal rupture. Data were collected on clinical, angiographic, and echocardiographic findings; operative procedures; early morbidity; and survival time. Univariable and multivariable analyses were performed to identify risk factors of 30-day mortality and total mortality.

Results: Thirty-day mortality was 33% altogether and decreased from 45% in the first half to 21% in the second half of the period (P = .01). Follow-up was a mean of 5.2 ± 6.2 years and a median of 2.9 years (range, 0–26.3 years). Five- and 10-year cumulative survival was 50% and 32%, respectively. Shock at surgical intervention and incomplete coronary revascularization were strong and independent risk factors of both 30-day mortality and poor long-term survival.

Conclusions: Early outcome after repair of ventricular septal rupture improved significantly during time, with 30-day mortality being 21% in the last decade. Five- and 10-year cumulative survival was 50% and 32%, respectively. Shock at surgical intervention and incomplete coronary revascularization were strong and independent predictors of poor early and late survival.

Abbreviations and Acronyms AMI = acute myocardial infarction; ASAT = aspartate aminotransferase; CABG = coronary artery bypass grafting; CPB = cardiopulmonary bypass; IABP = intra-aortic balloon pump; PCI = percutaneous coronary intervention; VSR = ventricular septal rupture




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