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Jhand A, Elgendy IY. Transcatheter Closure of Postinfarct Ventricular Septal Defect: Promises and Uncertainties. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:102071. [PMID: 39132599 PMCID: PMC11308426 DOI: 10.1016/j.jscai.2024.102071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 08/13/2024]
Affiliation(s)
- Aravdeep Jhand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Islam Y. Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky
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2
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Cubeddu RJ, Lorusso R, Ronco D, Matteucci M, Axline MS, Moreno PR. Ventricular Septal Rupture After Myocardial Infarction: JACC Focus Seminar 3/5. J Am Coll Cardiol 2024; 83:1886-1901. [PMID: 38719369 DOI: 10.1016/j.jacc.2024.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/07/2023] [Accepted: 01/03/2024] [Indexed: 06/05/2024]
Abstract
Ventricular septal rupture remains a dreadful complication of acute myocardial infarction. Although less commonly observed than during the prethrombolytic era, the condition remains complex and is often associated with refractory cardiogenic shock and death. Corrective surgery, although superior to medical treatment, has been associated with high perioperative morbidity and mortality. Transcatheter closure techniques are less invasive to surgery and offer a valuable alternative, particularly in patients with cardiogenic shock. In these patients, percutaneous mechanical circulatory support represents a novel opportunity for immediate stabilization and preserved end-organ function. Multimodality imaging can identify favorable septal anatomy for the most appropriate type of repair. The heart team approach will define optimal timing for surgery vs percutaneous repair. Emerging concepts are proposed for a deferred treatment approach, including orthotropic heart transplantation in ideal candidates. Finally, for futile situations, palliative care experts and a medical ethics team will provide the best options for end-of-life clinical decision making.
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Affiliation(s)
- Roberto J Cubeddu
- Division of Cardiology, Section for Structural Heart Disease, Naples Comprehensive Health Rooney Heart Institute, Naples Comprehensive Health Healthcare System, Naples, Florida, USA; Igor Palacios Fellows Foundation, Boston, Massachusetts, USA
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Daniele Ronco
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Cardiac Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Matteucci
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Cardiac Surgery Unit, ASSTSette Laghi, Varese, Italy
| | - Michael S Axline
- Division of Cardiology, Section for Structural Heart Disease, Naples Comprehensive Health Rooney Heart Institute, Naples Comprehensive Health Healthcare System, Naples, Florida, USA
| | - Pedro R Moreno
- Igor Palacios Fellows Foundation, Boston, Massachusetts, USA; Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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3
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Ghosh S, Halder V, Mishra A, Haranal M, Aggarwal P, Barwad P, Singh H, Thingnam S, Bansal V. Surgical Outcomes of Post-myocardial Infarction Ventricular Septal Defect/Rupture: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e44135. [PMID: 37752999 PMCID: PMC10518374 DOI: 10.7759/cureus.44135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
Ventricular septal defect (VSD) is a catastrophic acute myocardial infarction (MI) complication. Despite a significant reduction in the prevalence of post-MI VSD with the advancement of surgical techniques, it is still considered fatal with a high mortality rate. The trends in the clinical outcomes of patients with post-MI VSD show discretion due to the complexity of the disease. Therefore, the present analysis aimed to evaluate the surgical outcomes and associated risks in the patients of post-MI VSD. A thorough literature survey resulted in 40 studies of our interest. The pooled proportion of differential variables, including the incidence of cardiogenic shock, 30-day survival, and overall mortality, were estimated using Bayesian hierarchical models. The risk difference was estimated for the location of MI and VSD and mortality in patients with coronary artery bypass graft (CABG). In addition, the heterogeneity tests for inconsistency and publication biases using Egger's and Begg's tests were also estimated. The analysis revealed a significant risk difference of 0.23 and 0.27 for the anterior vs. posterior location of MI and VSD, respectively. Further, the pooled proportion of 30-day survival and mortality was found to be 54.43% (95% credible interval (CI): 52.88-55.98%) and 48.22% (95% CI: 4-12.3%), respectively. Moreover, the heterogeneity test revealed significant inconsistencies in all the datasets with an I2 index of >90% (p<0.0001). Lastly, the publication bias results suggested no evidence of asymmetry and small-study effects. Conclusively, the surgical management of post-MI VSD patients is considered beneficial; however, the outcomes signify its fatal behavior.
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Affiliation(s)
- Soumitra Ghosh
- Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, IND
| | - Vikram Halder
- Cardiothoracic Surgery, U. N. Mehta Institute of Cardiology & Research Centre, Ahmedabad, IND
| | - Amit Mishra
- Cardiothoracic Surgery, U. N. Mehta Institute of Cardiology & Research Centre, Ahmedabad, IND
| | - Maruti Haranal
- Cardiothoracic Surgery, U. N. Mehta Institute of Cardiology & Research Centre, Ahmedabad, IND
| | - Pankaj Aggarwal
- Cardiothoracic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Parag Barwad
- Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Harkant Singh
- Cardiothoracic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Shyam Thingnam
- Cardiothoracic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Vidur Bansal
- Cardiothoracic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
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4
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Perez-Villa B, Cubeddu RJ, Brozzi N, Sleiman JR, Navia J, Hernandez-Montfort J. Transition to heart transplantation in post-myocardial infarction ventricular septal rupture: a systematic review. Heart Fail Rev 2023; 28:217-227. [PMID: 34674096 DOI: 10.1007/s10741-021-10161-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 02/07/2023]
Abstract
Post-myocardial infarction ventricular septal rupture (MI-VSR) remains a dreadful complication with dismal prognosis. Surgical repair is the primary treatment strategy, whereas the role of heart transplantation (HT) as a primary option in MI-VSR is limited to case reports (CRs). We performed a systematic review of CRs to describe in-hospital mortality, and survival at 6 and 12 months in adult patients with MI-VSR treated with HT as a primary or bailout strategy. We performed a comprehensive search of Web of Science, PubMed, and Ovid Medline. The last search was completed on March 10, 2020. An aggregated score based on the CARE case report guideline was used to assess the quality of the CRs. We included CRs that described adult patients with MI-VSR treated with HT as a primary or bailout strategy. A total of 14 CRs between 1994 and 2015 were included, retrieving and analyzing the characteristics of 17 patients. A total of 12 patients underwent HT, with HT being the primary strategy in 8 patients and a bailout strategy for 4 patients following initial surgical repair, while 5 patients died awaiting HT under mechanical circulatory support (MCS), accounting for the total in-hospital mortality of this series (29%). Regarding long-term outcomes, 6 patients were reported to be alive at 6 months and 1 year after HT, while information was missing in the remaining 6 patients. In conclusion, HT supported by the use of temporary and durable MCS as a bridge to HT could be a feasible primary or bailout strategy to reduce the high in-hospital mortality of patients with MI-VSR.
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Affiliation(s)
- Bernardo Perez-Villa
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Florida, FL, Weston, USA.
| | | | - Nicolas Brozzi
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Florida, FL, Weston, USA
| | - Jose R Sleiman
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Florida, FL, Weston, USA
| | - Jose Navia
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Florida, FL, Weston, USA
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5
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Belyaev AM, Skopin II, Lobacheva GV, Alshibaya MD. The combination of Euroscore II with a new variable "Nongraftable coronary artery lesions" improves the discriminating power of the test in surgical patients with postinfarction ventricular septal defect and ventricular aneurysm. J Card Surg 2022; 37:4952-4961. [PMID: 36378876 DOI: 10.1111/jocs.17181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aimed to establish whether Euroscore II can be used for the prediction of hospital mortality in surgical patients with postinfarction intraventricular septal defect (PIVSD) and ventricular aneurysm (VA), and coexisting coronary artery lesions (CALs), and identify perioperative mortality risk factors to improve the discriminating power of Euroscore II. METHODS This was a retrospective observational study. The inclusion criterion was PIVSD. Exclusion criteria were previous CABG, conservative treatment, percutaneous transcatheter closure of PIVSDs, and PIVSDs with normal coronary arteries on coronary angiography. RESULTS Among 53 patients with PIVSDs and VAs who met eligibility criteria, 12 (22.6%) patients died in the hospital. Logistic regression demonstrated that Euroscore II was associated with in-hospital mortality (odds ratio [OR] = 1.13; 95% confidence interval [CI]: 1.03-1.23; p = .006), well-calibrated (Hosmer-Lemeshow χ2 (8) = 9.75; p = .283), and had fair discriminating power, area under receiver operating characteristic curve (AUC) = 77% (95% CI: 58%-96%). A newly identified variable "Nongraftable CALs" was associated with in-hospital mortality (OR = 6.65; 95% CI: 1.24-35.53; p = .027), and had a fair discriminating power, AUC = 70% (95% CI: 54%-85%). When Euroscore II and Nongraftable CALs were combined, the discriminating power of the test increased to 83% (95% CI: 71%-95%), p = .036. CONCLUSION Euroscore II has adequate discriminating power and good calibration in predicting in-hospital mortality of surgical patients with PIVSDs and VAs. The combination of Euroscore II with a new variable "Nongraftable CALs" significantly improves the performance of the model.
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Affiliation(s)
- Andrei M Belyaev
- Department of Surgical Treatment of Ischemic Heart Disease, Bakoulev's National Medical Research Centre for Cardiac Surgery, Moscow, Russia
| | - Ivan I Skopin
- Department of Surgical Treatment of Ischemic Heart Disease, Bakoulev's National Medical Research Centre for Cardiac Surgery, Moscow, Russia
| | - Galina V Lobacheva
- Intensive Care Unit, Department of Anesthesia and Intensive Care Medicine, Bakoulev's National Medical Research Centre for Cardiac Surgery, Moscow, Russia
| | - Mikhail D Alshibaya
- Department of Surgical Treatment of Ischemic Heart Disease, Bakoulev's National Medical Research Centre for Cardiac Surgery, Moscow, Russia
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6
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Ronco D, Matteucci M, Massimi G, Lorusso R. Concomitant surgical revascularization in postinfarction ventricular septal rupture and ventricular aneurysm repair: A straightforward indication or a prognostic factor? J Card Surg 2022; 37:2703-2705. [PMID: 35703120 PMCID: PMC9543386 DOI: 10.1111/jocs.16673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Daniele Ronco
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Matteo Matteucci
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Giulio Massimi
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Cardiac Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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7
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Belyaev AM, Skopin II, Lobacheva GV, Alshibaya MD. Complete anatomic surgical myocardial revascularisation during postinfarction ventricular septal defect and ventricular aneurysm repair is associated with improved short- and long-term outcomes. J Card Surg 2022; 37:2693-2702. [PMID: 35690901 DOI: 10.1111/jocs.16675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/23/2022] [Accepted: 05/11/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) is recommended during acute postinfarction ventricular septal defect (PIVSD) repair, but clinical benefits of surgical revascularization in patients with subacute PIVSD have not been established. We aimed to evaluate the association of primary complete anatomic surgical myocardial revascularization (CASMR) during PIVSD and ventricular aneurysm (VA) repair on patients' short- and long-term outcomes. METHODS This was a retrospective observational study. The inclusion criterion was PIVSD. Patients with previous CABG and those with PIVSD due to vasospasm and normal coronary arteries on angiography were excluded. RESULTS From March 2002 to April 2021, 53 patients met the eligibility criteria. The median patient age was 65 years, and 28 (53%) were male. Compared to the non-CABG group, CABG patients had higher values of the median postoperative left ventricular (LV) end-diastolic volume, 100 ml, and 128.5 ml, respectively (p = .012), and the mean LV stroke volume, 49 ml, and 61 ml, respectively (p = .048). The mortality rates in the CABG and non-CABG groups were 3.6/100 person-years (95% confidence interval [CI]: 1.5-8.6/100 person-years) and 16.3/100 person-years (95% CI: 8.5-31.3/100 person-years), respectively. Cox regression adjusted for between groups imbalances demonstrated a 4-fold greater mortality risk (hazard ratio = 4.3; 95% CI: 1.1-16.7; p = .036) among the non-CABG patients than in the CABG patients. Kaplan-Meier survival analysis yielded a poorer overall survival of the non-CABG patients (p = .011). CONCLUSION Primary CASMR during PIVSD and VA repair is associated with improved postoperative cardiac function, lower hospital mortality, and better long-term survival. We recommend CASMR during PIVSD and VA repair.
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Affiliation(s)
- Andrei M Belyaev
- Department of Surgical Treatment of Ischemic Heart Disease, Bakoulev's National Medical Research Centre for Cardiac Surgery, Moscow, Russia
| | - Ivan I Skopin
- Department of Surgical Treatment of Ischemic Heart Disease, Bakoulev's National Medical Research Centre for Cardiac Surgery, Moscow, Russia
| | - Galina V Lobacheva
- Intensive Care Unit, Bakoulev's National Medical Research Centre for Cardiac Surgery, Moscow, Russia
| | - Mikhail D Alshibaya
- Department of Surgical Treatment of Ischemic Heart Disease, Bakoulev's National Medical Research Centre for Cardiac Surgery, Moscow, Russia
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8
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Yousef S, Sultan I, VonVille HM, Kahru K, Arnaoutakis GJ. Surgical management for mechanical complications of acute myocardial infarction: a systematic review of long-term outcomes. Ann Cardiothorac Surg 2022; 11:239-251. [PMID: 35733723 PMCID: PMC9207694 DOI: 10.21037/acs-2021-ami-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/12/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND Mechanical complications following acute myocardial infarction (AMI), though rare, are associated with significant morbidity and mortality. Surgical management remains a mainstay of therapy for these complications. The purpose of this review is to evaluate long-term outcomes data of surgical management for postinfarction free wall rupture, ventricular septal defect, papillary muscle rupture, and pseudoaneurysm. METHODS An electronic literature search was performed to identify original studies reporting long-term outcomes data of surgical management of one of the four mechanical complications following AMI. Studies were considered to have long-term outcomes if they at minimum included survival or mortality data up to one year. RESULTS A total of 285 studies were identified from the literature search. Of these, 29 studies with long-term survival data on surgically managed mechanical complications of AMI are included in the review. The majority of these are retrospective cohort studies or single-center case series. Five studies are included on free wall rupture, 18 on ventricular septal defect, 4 on papillary muscle rupture, and 2 on pseudoaneurysm. Detailed results are tabulated according to complication. CONCLUSIONS Long-term surgical outcomes of postinfarction mechanical complications remain understudied. Outcomes for ventricular septal defect repair are better represented in the literature than are outcomes for other mechanical complications, though available studies are still limited by small sample sizes and retrospective design. Further research is warranted, particularly for outcomes of acute pseudoaneurysm repair.
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Affiliation(s)
- Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Helena M VonVille
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kevin Kahru
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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9
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Yousef S, Sultan I. Surgical repair for post-infarction papillary muscle rupture: where do we stand? Eur J Cardiothorac Surg 2021; 61:477-478. [PMID: 34927203 DOI: 10.1093/ejcts/ezab534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/24/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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10
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Dimagli A, Guida G, Sinha S, Dixon L, Fudulu D, Gemelli M, Benedetto U, Angelini GD. Surgical outcomes of post-infarct ventricular septal defect repair: Insights from the UK national adult cardiac surgery audit database. J Card Surg 2021; 37:843-852. [PMID: 34910324 DOI: 10.1111/jocs.16178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Ventricular septal defect (VSD) is becoming a progressively less frequent mechanical complication of myocardial infarction (MI). However, this event is still associated with high operative mortality. We aimed to describe the trends and the risk factors associated with surgical VSD repair outcomes and to provide a clinical benchmark for percutaneous VSD closure strategies. METHODS Using the UK National Adult Cardiac Surgery Audit database, we identified 1010 patients undergoing surgical VSD repair from 1996 to 2018. The primary outcome was operative mortality. Mixed-model, multivariable logistic regression was used to identify the risk factors associated with operative mortality taking into account the variation related to the centre, the surgeon and the year of the operation. RESULTS Both the number of surgical VSD repair and the mortality rate did not change significantly over the 23-year timeframe. Operative mortality was 38.9% overall and was higher when patients were operated within the first 6 h (75%) or the first 24 h (61.3%) from the index MI. Risk factors associated with higher odds of mortality were early surgery, older age, cardiogenic shock, renal failure, previous percutaneous coronary intervention and urgent/emergent operations. Moreover, the mortality rate was similar among patients undergoing isolated VSD repair and VSD repaired combined with surgical coronary revascularization alone or with concomitant mitral valve procedures. CONCLUSIONS Post MI VSD remains a dreaded mechanical complication characterized by high surgical operative mortality. A delayed operation, whenever possible, appears to be the most beneficial strategy to reduce mortality.
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Affiliation(s)
| | - Gustavo Guida
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Shubhra Sinha
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Lauren Dixon
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Daniel Fudulu
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Marco Gemelli
- Bristol Heart Institute, University of Bristol, Bristol, UK
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11
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Malik J, Younus F, Malik A, Farooq MU, Kamal A, Shoaib M, Naeem H, Rana G, Rana AS, Usman M, Khalil S. One-year outcome and survival analysis of deferred ventricular septal repair in cardiogenic shock supported with mechanical circulatory support. PLoS One 2021; 16:e0256377. [PMID: 34407147 PMCID: PMC8372898 DOI: 10.1371/journal.pone.0256377] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/04/2021] [Indexed: 11/19/2022] Open
Abstract
Background and objective The effectiveness of deferred surgical repair of ventricular septal rupture (VSR) post-myocardial infarction (MI) with cardiogenic shock remains limited to case reports. Our study aimed to investigate the outcomes and survival analysis following mechanical circulatory support (MCS) in patients after VSR who develop cardiogenic shock. Methods We analyzed 27 patients with post-MI VSR and cardiogenic shock who received deferred surgical repair while stabilized on MCS between January 2018 and March 2020. After normality test adjustments, continuous variables were expressed as mean ± standard deviation (SD). These were compared using the Mann-Whitney U test and Student’s t-test. Categorical variables were compared using chi-square or Fisher’s exact test. To identify predictors of operative mortality, univariate analysis of clinical characteristics and interventions followed by logistic regression was carried out. P-value of < 0.05 was considered significant. Results All patients had preoperative MCS. Emergency repair was avoided in all the patients. The mean age of the participants was 64.96 with the majority being males (74.1%). On average, the mean time from MI to VSR repair was 18.85 days. Delayed revascularization was associated with increased mortality (OR 17.500, 95% CI 2.365–129.506, P = 0.005). Other factors associated with increased mortality were ejection fraction (EF), three-vessel disease, Killip class, early surgery, and prolonged use of inotropes. The operative mortality was 11% with an overall mortality of 33.3%. The one-year survival rate was 66.7%. Conclusion The use of MCS in adjunct to a deferred surgical approach shows an improved survival outcome of patients with VSR complicated by cardiogenic shock. Further investigations are required regarding the optimal time for MCS and surgical repair.
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Affiliation(s)
- Jahanzeb Malik
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawal Road, Rawalpindi, Pakistan
- * E-mail:
| | - Faizan Younus
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawal Road, Rawalpindi, Pakistan
| | - Asmara Malik
- Department of Community Medicine, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Muhammad Umar Farooq
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawal Road, Rawalpindi, Pakistan
| | - Ahmed Kamal
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawal Road, Rawalpindi, Pakistan
| | - Muhammad Shoaib
- Department of Cardiology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Hesham Naeem
- Department of Cardiothoracic Surgery, Mega Medical Complex Hospital, Rawalpindi, Pakistan
| | - Ghazanfar Rana
- Department of Cardiology, St. Luke’s General Hospital, Kilkenny, Ireland
| | - Abdul Sattar Rana
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawal Road, Rawalpindi, Pakistan
| | - Muhammad Usman
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawal Road, Rawalpindi, Pakistan
| | - Shahid Khalil
- Department of Cardiothoracic Surgery, Mega Medical Complex Hospital, Rawalpindi, Pakistan
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12
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Damluji AA, van Diepen S, Katz JN, Menon V, Tamis-Holland JE, Bakitas M, Cohen MG, Balsam LB, Chikwe J. Mechanical Complications of Acute Myocardial Infarction: A Scientific Statement From the American Heart Association. Circulation 2021; 144:e16-e35. [PMID: 34126755 DOI: 10.1161/cir.0000000000000985] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Over the past few decades, advances in pharmacological, catheter-based, and surgical reperfusion have improved outcomes for patients with acute myocardial infarctions. However, patients with large infarcts or those who do not receive timely revascularization remain at risk for mechanical complications of acute myocardial infarction. The most commonly encountered mechanical complications are acute mitral regurgitation secondary to papillary muscle rupture, ventricular septal defect, pseudoaneurysm, and free wall rupture; each complication is associated with a significant risk of morbidity, mortality, and hospital resource utilization. The care for patients with mechanical complications is complex and requires a multidisciplinary collaboration for prompt recognition, diagnosis, hemodynamic stabilization, and decision support to assist patients and families in the selection of definitive therapies or palliation. However, because of the relatively small number of high-quality studies that exist to guide clinical practice, there is significant variability in care that mainly depends on local expertise and available resources.
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13
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Shimahara Y, Fukushima S, Yajima S, Tadokoro N, Kakuta T, Asaumi Y, Kobayashi J, Fujita T. Emergency sandwich patch repair via right ventricular incision for postinfarction ventricular septal defects: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab141. [PMID: 34268476 PMCID: PMC8276610 DOI: 10.1093/ehjcr/ytab141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/30/2020] [Accepted: 03/29/2021] [Indexed: 11/23/2022]
Abstract
Background The surgical treatment for postinfarction ventricular septal defect (VSD) remains
challenging, especially in emergency cases. Several authors have reported the efficacy
of a sandwich patch VSD repair via a right ventricular (RV) incision.
However, this procedure remains uncommon, and its efficacy is still unknown, especially
when performed under an emergency. Case summary We were able to perform sandwich patch VSD repair via an RV incision
on seven consecutive patients with VSD following an ST-segment elevation myocardial
infarction (STEMI) from March 2017 to December 2019. Bovine pericardial patches were
used for sandwich patches. Two patients developed inferior STEMI, and the other patients
developed anterior STEMI. Six patients received intra-aortic balloon pump prior to
surgery, and the other received extracorporeal membrane oxygenation with Impella. The
interval between the diagnosis of VSD and surgery was within 1 day in all patients
except one (5 days). All seven patients underwent VSD repair in the emergency status.
Four patients underwent concomitant coronary artery bypass grafting. The hospital
mortality rate was 14.3% (1/7). Early postoperative transthoracic echocardiography
revealed that only one patient developed more than trace residual shunt. The
postoperative right atrial pressure was not significantly elevated at ≤12 mmHg in all
patients. No patient developed early postoperative prolonged low cardiac output
syndrome. Discussion In patients with postinfarction VSD, a sandwich patch VSD repair via
an RV incision is a promising procedure with a low incidence of residual shunt
development and hospital mortality, even in emergency cases.
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Affiliation(s)
- Yusuke Shimahara
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular
Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565,
Japan
- Corresponding author. Tel: +81 6 6170 1070, Fax: +81 6 6170 1782,
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular
Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565,
Japan
| | - Shin Yajima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular
Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565,
Japan
| | - Naoki Tadokoro
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular
Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565,
Japan
| | - Takashi Kakuta
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular
Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565,
Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular
Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565,
Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular
Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565,
Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular
Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565,
Japan
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14
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Bowdish ME, D'Agostino RS, Thourani VH, Schwann TA, Krohn C, Desai N, Shahian DM, Fernandez FG, Badhwar V. STS Adult Cardiac Surgery Database: 2021 Update on Outcomes, Quality, and Research. Ann Thorac Surg 2021; 111:1770-1780. [PMID: 33794156 DOI: 10.1016/j.athoracsur.2021.03.043] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 12/27/2022]
Abstract
The Society of Thoracic Surgeons Adult Cardiac Surgery Database is the most mature and comprehensive cardiac surgery database. It has been the foundation for quality measurement and improvement activities in cardiac surgery, facilitated the generation of accurate risk adjusted performance benchmarks and serves as a platform for novel research. Recent enhancements have added to the database's functionality, ease of use, and value to multiple stakeholders. This report is the sixth in a series of annual reports that provide updated volumes, outcomes, database-related developments, quality improvement initiatives, and research summaries using the Adult Cardiac Surgery Database in the past year.
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Affiliation(s)
- Michael E Bowdish
- Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California.
| | - Richard S D'Agostino
- Division of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts; Department of Surgery, Division of Cardiothoracic Surgery, Tufts University School of Medicine, Boston, Massachusetts
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Thomas A Schwann
- Division of Cardiac Surgery, University of Massachusetts Medical School - Baystate, Springfield, Massachusetts
| | - Carole Krohn
- The Society of Thoracic Surgeons, Chicago, Illinois
| | - Nimesh Desai
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David M Shahian
- Division of Cardiac Surgery, Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Felix G Fernandez
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
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