Surgical treatment of postinfarction ventricular septal defect: risk factors and outcome analysis
| Autor: | Nedal Omran, Jan Harrer, Marek Pojar, Jana Striteska, Zdenek Turek, Jan Vojáček |
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| Rok vydání: | 2017 |
| Předmět: |
Pulmonary and Respiratory Medicine
Heart Septal Defects Ventricular Male medicine.medical_specialty medicine.medical_treatment Myocardial Infarction 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine medicine Humans cardiovascular diseases Myocardial infarction Renal replacement therapy Coronary Artery Bypass Survival rate Killip class Aged Retrospective Studies Univariate analysis business.industry Mortality rate Middle Aged medicine.disease Survival Rate Treatment Outcome 030228 respiratory system Concomitant Multivariate Analysis Cardiology Surgery Female Cardiology and Cardiovascular Medicine Complication business |
| Zdroj: | Interactive cardiovascular and thoracic surgery. 26(1) |
| ISSN: | 1569-9285 |
| Popis: | OBJECTIVES Postinfarction ventricular septal defect is a serious mechanical complication of acute myocardial infarction associated with high postoperative mortality. The aim of this study was to review our experience with surgical repair of postinfarction ventricular septal defect and to identify predictors of early and late outcomes. METHODS Thirty-nine patients (19 men and 20 women, mean age 68.4 ± 9.9 years) with postinfarction ventricular septal defect who underwent surgical repair at our institution between 1996 and 2016 were retrospectively evaluated. Risk factors were assessed by univariate analysis, with those found significant included in multivariate analysis. RESULTS The ventricular septal defect was anterior in 21 (54%) patients and posterior in 18 (46%) patients. Mean aortic cross-clamp time was 91.8 ± 26.8 min, and mean cardiopulmonary bypass time was 146.3 ± 49.7 min. Twelve (31%) patients underwent concomitant coronary artery bypass grafting. The 30-day mortality rate was 36% (n = 14). The 30-day survival rate was higher with than without concomitant coronary artery bypass grafting (83% vs 56%), but concomitant coronary artery bypass grafting did not influence late survival (P = 0.098). Univariate analysis identified age, emergency surgery, inotropic support, Killip class, preoperative aspartate aminotransferase concentration, renal replacement therapy and ventricular septal defect diagnosis to operation interval as predictors of 30-day mortality. However, multivariate analysis showed that age and renal replacement therapy were the only independent risk factors of 30-day mortality. CONCLUSIONS Surgical repair of postinfarction ventricular septal defect has a high 30-day mortality rate. Higher age at presentation and postoperative renal replacement therapy are independent predictors of early mortality. |
| Databáze: | OpenAIRE |
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