Optimal surgical timing after post-infarction ventricular septal rupture.

Autor:	Sánchez Vega JD; Department of Cardiology, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERCV, Madrid, Spain., Alonso Salinas GL; Department of Cardiology, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERCV, Madrid, Spain.; Department of Cardiology, Complejo Hospitalario de Navarra, Pamplona, Spain., Viéitez Florez JM; Department of Cardiology, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERCV, Madrid, Spain.; Department of Cardiology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain., Ariza Solé A; Department of Cardiology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain., López de Sá E; Department of Cardiology, Hospital Universitario La Paz, IDIPAZ, Madrid, Spain.; Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain, Spain., Sanz-Ruiz R; Department of Cardiology, Hospital Universitario Gregorio Marañón, Madrid, Spain., Burgos Palacios V; Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain., Raposeiras Roubin S; Department of Cardiology, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain., Gómez Varela S; Department of Cardiology, Hospital Universitario de Cruces, Baracaldo, Sapin., Sanchís Forés J; Department of Cardiology, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain., Silva Melchor L; Department of Cardiology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain., Martínez-Seara X; Department of Cardiology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain., Malagón López L; Department of Cardiology, Complejo Hospitalario de Navarra, Pamplona, Spain., Viana Tejedor A; Department of Cardiology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Clínico San Carlos, Madrid, Spain., Corbí Pascual M; Department of Cardiology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain., Zamorano Gómez JL; Department of Cardiology, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERCV, Madrid, Spain., Sanmartín-Fernández M; Department of Cardiology, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERCV, Madrid, Spain. msanfer@me.com.
Jazyk:	angličtina
Zdroj:	Cardiology journal [Cardiol J] 2022; Vol. 29 (5), pp. 773-781. Date of Electronic Publication: 2022 May 17.
DOI:	10.5603/CJ.a2022.0035
Abstrakt:	Background: Ventricular septal rupture (VSR) following acute myocardial infarction (AMI) is a dangerous condition. Surgical VSR closure is the definitive therapy, but there is controversy regarding the surgical timing and the bridging therapy between diagnosis and intervention. The objective of this study is to analyze the ideal time of surgical repair and to establish the contribution of mechanical circulatory support (MCS) devices on the prognosis. Methods: We designed an observational, retrospective, multicenter study, selecting all consecutive patients with post-AMI VSR between January 1, 2008 and December 31, 2018, with non-exclusion criteria. The main objective of this study was to analyze the optimal timing for surgical repair of post-AMI VSR. Secondary endpoints were to determine which factors could influence mortality in the patients of the surgical group. Results: A total of 141 patients were included. We identified lower mortality rates with an odds ratio of 0.3 (0.1-0.9) in patients operated on from day 4 compared with the surgical mortality in the first 24 hours after VSR diagnosis. The use of MCS was more frequent in patients treated with surgery, particularly for intra-aortic balloon pump (IABP; 79.6% vs. 37.8%, p < 0.001), but also for veno-arterial extracorporeal membrane oxygenation (VA-ECMO; 18.2% vs. 6.4%, p = 0.134). Total mortality was 91.5% for conservative management and 52.3% with surgical repair (p < 0.001). Conclusions: In our study, we observed that the lowest mortality rates in patients with surgical repair of post-AMI VSR were observed in patients operated on from day 4 after diagnosis of VSR, compared to earlier interventions.
Databáze:	MEDLINE
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