Post-infarction ventricular septal defect: percutaneous or surgical management in the UK national registry

Mamas

Abstract

Background and Aims Postinfarction ventricular septal defect (PIVSD) is a mechanical complication of myocardial infarction (MI) with a poor prognosis. Surgical repair is the mainstay of treatment, although percutaneous closure is increasingly undertaken. Methods Patients treated with surgical or percutaneous repair of PIVSD (2010-2021) were identified at 16 UK centres. Case note review was undertaken. The primary outcome was long-term mortality. Patient groups were allocated based upon initial management (percutaneous or surgical). Results 362 patients received 416 procedures (131 percutaneous, 231 surgery). 16.1% of percutaneous patients subsequently had surgery. 7.8% of surgical patients subsequently had percutaneous treatment. Times from MI to treatment were the similar (percutaneous 9[6-14] vs. surgical 9[4-22] days, p=0.18). Surgical patients were more likely to have cardiogenic shock (62.8% vs. 51.9, p=0.044). Percutaneous patients were substantially older (72 [64-77] vs. 67[61-73] years, p<0.001), and more likely to be discussed in a heart team setting. There was no difference in long-term mortality between patients (61.1% vs. 53.7%, p=0.17). In-hospital mortality was lower in the surgical group (55.0% vs. 44.2%, p=0.048) with no difference in mortality after hospital discharge (p=0.65). Cardiogenic shock (1.97 [1.37-2.84], p<0.001), percutaneous approach (aHR 1.44 [1.01-2.05], p=0.042) and number of vessels with coronary artery disease (aHR 1.22 [1.01-1.47], p=0.043 were independently associated with long-term mortality. Conclusions Surgical and percutaneous repair are viable options for management of PIVSD. There was no difference in post-discharge long-term mortality between patients, although in-hospital mortality was lower for surgery.

Citation

Mamas. (2022). Post-infarction ventricular septal defect: percutaneous or surgical management in the UK national registry. European Heart Journal, 5020-5032. https://doi.org/10.1093/eurheartj/ehac511

• Journal Article Type: Article
• Acceptance Date: Sep 1, 2022
• Publication Date: Dec 21, 2022
• Publicly Available Date: Dec 22, 2023
• Journal: European Heart Journal
• Print ISSN: 0195-668X
• Publisher: Oxford University Press
• Pages: 5020-5032
• DOI: https://doi.org/10.1093/eurheartj/ehac511
• Public URL: https://keele-repository.worktribe.com/output/424423
• Publisher URL: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehac511/6696034