Surgical Treatment of Postinfarction Ventricular Septal Rupture.

Autor:	Ronco D; 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., Matteucci M; 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., Kowalewski M; Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.; Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland., De Bonis M; Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy., Formica F; Department of Medicine and Surgery, Cardiac Surgery Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.; Department of Medicine and Surgery, University of Parma, Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy., Jiritano F; Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.; Department of Experimental and Clinical Medicine, 'Magna Graecia' University of Catanzaro, Catanzaro, Italy., Fina D; Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.; Department of Cardiovascular Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, San Donato Milanese, Italy., Folliguet T; Department of Cardio-Thoracic Surgery, University Hospital Henri-Mondor, Assistance Publique-Hopitaux de Paris Créteil, Paris, France., Bonaros N; Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria., Russo CF; Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milan, Italy., Sponga S; Cardiothoracic Department, University Hospital of Udine, Udine, Italy., Vendramin I; Cardiothoracic Department, University Hospital of Udine, Udine, Italy., De Vincentiis C; Cardiac Surgery Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy., Ranucci M; Department of Cardiovascular Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, San Donato Milanese, Italy., Suwalski P; Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland., Falcetta G; Section of Cardiac Surgery, University Hospital, Pisa, Italy., Fischlein T; Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany., Troise G; Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy., Villa E; Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy., Dato GA; Cardiac Surgery Department, Mauriziano Hospital, Turin, Italy., Carrozzini M; Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milan, Italy., Serraino GF; Department of Experimental and Clinical Medicine, 'Magna Graecia' University of Catanzaro, Catanzaro, Italy., Shah SH; Cardiovascular and Thoracic Surgery Department, King Fahad Medical City, Riyadh, Saudi Arabia., Scrofani R; Cardiac Surgery Unit, Luigi Sacco Hospital, Milan, Italy., Fiore A; Department of Cardio-Thoracic Surgery, University Hospital Henri-Mondor, Assistance Publique-Hopitaux de Paris Créteil, Paris, France., Kalisnik JM; Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany., D'Alessandro S; Department of Medicine and Surgery, Cardiac Surgery Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy., Lodo V; Cardiac Surgery Department, Mauriziano Hospital, Turin, Italy., Kowalówka AR; Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland.; Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland., Deja MA; Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland.; Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland., Almobayedh S; Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands., Massimi G; Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands., Thielmann M; Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University of Duisburg-Essen, Essen, Germany., Meyns B; Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium., Khouqeer FA; Department of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia., Al-Attar N; Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, Scotland., Pozzi M; Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France., Obadia JF; Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France., Boeken U; Department of Cardiovascular Surgery, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany., Kalampokas N; Department of Cardiovascular Surgery, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany., Fino C; Cardiovascular and Transplant Department, Papa Giovanni XXIII Hospital, Bergamo, Italy., Simon C; Cardiovascular and Transplant Department, Papa Giovanni XXIII Hospital, Bergamo, Italy., Naito S; Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany., Beghi C; Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy., Lorusso R; Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.; Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2021 Oct 01; Vol. 4 (10), pp. e2128309. Date of Electronic Publication: 2021 Oct 01.
DOI:	10.1001/jamanetworkopen.2021.28309
Abstrakt:	Importance: Ventricular septal rupture (VSR) is a rare but life-threatening mechanical complication of acute myocardial infarction associated with high mortality despite prompt treatment. Surgery represents the standard of care; however, only small single-center series or national registries are usually available in literature, whereas international multicenter investigations have been poorly carried out, therefore limiting the evidence on this topic. Objectives: To assess the clinical characteristics and early outcomes for patients who received surgery for postinfarction VSR and to identify factors independently associated with mortality. Design, Setting, and Participants: The Mechanical Complications of Acute Myocardial Infarction: an International Multicenter Cohort (CAUTION) Study is a retrospective multicenter international cohort study that includes patients who were treated surgically for mechanical complications of acute myocardial infarction. The study was conducted from January 2001 to December 2019 at 26 different centers worldwide among 475 consecutive patients who underwent surgery for postinfarction VSR. Exposures: Surgical treatment of postinfarction VSR, independent of the technique, alone or combined with other procedures (eg, coronary artery bypass grafting). Main Outcomes and Measures: The primary outcome was early mortality; secondary outcomes were postoperative complications. Results: Of the 475 patients included in the study, 290 (61.1%) were men, with a mean (SD) age of 68.5 (10.1) years. Cardiogenic shock was present in 213 patients (44.8%). Emergent or salvage surgery was performed in 212 cases (44.6%). The early mortality rate was 40.4% (192 patients), and it did not improve during the nearly 20 years considered for the study (median [IQR] yearly mortality, 41.7% [32.6%-50.0%]). Low cardiac output syndrome and multiorgan failure were the most common causes of death (low cardiac output syndrome, 70 [36.5%]; multiorgan failure, 53 [27.6%]). Recurrent VSR occurred in 59 participants (12.4%) but was not associated with mortality. Cardiogenic shock (survived: 95 [33.6%]; died, 118 [61.5%]; P < .001) and early surgery (time to surgery ≥7 days, survived: 105 [57.4%]; died, 47 [35.1%]; P < .001) were associated with lower survival. At multivariate analysis, older age (odds ratio [OR], 1.05; 95% CI, 1.02-1.08; P = .001), preoperative cardiac arrest (OR, 2.71; 95% CI, 1.18-6.27; P = .02) and percutaneous revascularization (OR, 1.63; 95% CI, 1.003-2.65; P = .048), and postoperative need for intra-aortic balloon pump (OR, 2.98; 95% CI, 1.46-6.09; P = .003) and extracorporeal membrane oxygenation (OR, 3.19; 95% CI, 1.30-7.38; P = .01) were independently associated with mortality. Conclusions and Relevance: In this study, surgical repair of postinfarction VSR was associated with a high risk of early mortality; this risk has remained unchanged during the last 2 decades. Delayed surgery seemed associated with better survival. Age, preoperative cardiac arrest and percutaneous revascularization, and postoperative need for intra-aortic balloon pump and extracorporeal membrane oxygenation were independently associated with early mortality. Further prospective studies addressing preoperative and perioperative patient management are warranted to hopefully improve the currently suboptimal outcome.
Databáze:	MEDLINE
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