Percutaneous Closure of Post-infarction and Iatrogenic Ventricular Septal Ruptures Using Amplatzer Occluder®: A Systematic Review
Autor: | Sudhanva Hegde, Apoorva Jayaranagaiah, Ashkan Tadayoni, Amog Jayarangaiah, Isabel M. McFarlane, Pramod Theetha Kariyanna |
---|---|
Rok vydání: | 2021 |
Předmět: |
Surgical repair
medicine.medical_specialty Percutaneous business.industry medicine.medical_treatment Infarction 030204 cardiovascular system & hematology medicine.disease Article Atrial septal defects Septal myectomy Surgery Ventricular Septal Rupture 03 medical and health sciences 0302 clinical medicine 030228 respiratory system Valve replacement medicine General Earth and Planetary Sciences business Survival rate General Environmental Science |
Zdroj: | American journal of medical case reports |
ISSN: | 2374-2151 |
Popis: | Ventricular septal rupture (VSR) is a rare complication of myocardial infarction (MI), open heart surgery, and cardiac-based procedures, such as septal myectomy and valve replacement. VSR is associated with high mortality rates and the reported 30-day survival rate is less than 10% without any interventional therapy. Hence, prompt diagnosis and aggressive medical treatment with appropriate surgical intervention are necessary to improve survival. Immediate surgical intervention which is the standard treatment of VSR has a mortality rate of 19-60%. Due to persistent high mortality rate and challenging management of VSR, alternatives to surgical repair has been proposed; transcatheter approach as a new alternative method has been used for the closure of post-surgery residual defects or as a bridge to surgery and in some cases as a definitive therapy instead of surgical repair. Amplatzer Occluder® (AO), a type of transcatheter closure devices, is an approved method of repairing congenital atrial septal defects and it is being used as an alternative method of treatment in VSR. In this systemic review, we assessed the cases of VSR who underwent septal repair by using AO. The study shows that the total mortality rate of percutaneous VSR repair with AO is 20% which is comparable to 19-60% rate of death in patients who undergo surgery. While early intervention is necessary to prevent biventricular dysfunction, immediate surgical intervention on soft and friable tissue surrounding the infarction increases the risk of residual shunt and reoperation. However, this study reveals that the mortality rate of primary percutaneous VSR closure within 7 days of VSR detection was 37 % which is significantly lower than 60% in surgical repair in the same period. In conclusion, given that the prevalence of residual leak in both interventions are similar and close to 20%, percutaneous VSR closure with AO device could be superior to the surgical repair as a primary intervention in unstable or high-risk surgical patients. |
Databáze: | OpenAIRE |
Externí odkaz: |