Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the Society of Thoracic Surgeons National Database

Abstract

Background: The development of a ventricular septal defect (VSD) after myocardial infarction (MI) is an uncommon but highly lethal complication. We examined The Society of Thoracic Surgeons database to characterize patients undergoing surgical repair of post-MI VSD and to identify risk factors for poor outcomes.

Methods: This was a retrospective review of The Society of Thoracic Surgeons database to identify adults (aged≥18 years) who underwent post-MI VSD repair between 1999 and 2010. Patients with congenital heart disease were excluded. The primary outcome was operative death. The covariates in the current The Society of Thoracic Surgeons model for predicted coronary artery bypass grafting operative death were incorporated in a logistic regression model in this cohort.

Results: The study included 2,876 patients (1,624 men [56.5%]), who were a mean age of 68±11 years. Of these, 215 (7.5%) had prior coronary artery bypass grafting operations, 950 (33%) had prior percutaneous intervention, and 1,869 (65.0%) were supported preoperatively with an intraaortic balloon pump. Surgical status was urgent in 1,007 (35.0%) and emergencies in 1,430 (49.7%). Concomitant coronary artery bypass grafting was performed in 1,837 (63.9%). Operative mortality was 54.1% (1,077 of 1,990) if repair was within 7 days from MI and 18.4% (158 of 856) if more than 7 days from MI. Multivariable analysis identified several factors associated with increased odds of operative death.

Conclusions: In the largest study to date to examine post-MI VSD repair, ventricular septal rupture remains a devastating complication. As alternative therapies emerge to treat this condition, these results will serve as a benchmark for future comparisons.

Conflict of interest statement

Conflicts: Dr. Conte receives research support from Thoratec and Medtronic.

Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

a: Number of post-MI VSD surgical procedures by year. Data for 2010 only included first quarter data harvest. b: Post-MI VSD surgical procedures performed as percentage of total cardiac operations reported to the STS database by year. c: Post-MI VSD surgical procedures performed as percentage of total isolated CABG procedures reported to the STS database by year.

Figure 1

a: Number of post-MI VSD surgical procedures by year. Data for 2010 only included first quarter data harvest. b: Post-MI VSD surgical procedures performed as percentage of total cardiac operations reported to the STS database by year. c: Post-MI VSD surgical procedures performed as percentage of total isolated CABG procedures reported to the STS database by year.

Figure 1

a: Number of post-MI VSD surgical procedures by year. Data for 2010 only included first quarter data harvest. b: Post-MI VSD surgical procedures performed as percentage of total cardiac operations reported to the STS database by year. c: Post-MI VSD surgical procedures performed as percentage of total isolated CABG procedures reported to the STS database by year.

Figure 2

Operative mortality for each year of the study.

Figure 3

Operative mortality according to timing of MI in relation to VSD repair. P

Figure 4

Odds ratio plot of variables included in the reduced risk-adjusted logistic regression model for operative mortality. Year of surgery controlled for in the regression model. Diamonds represent actual odds ratio values and gray bars denote 95%CI. C-index for the reduced model was 0.79.