Clinical results of surgical repair combining an occluder and a patch for ventricular septal rupture after myocardial infarction_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHOU Jiawei , YAO Xingxing , SUN Fuqiang , GUO Bowen , ZOU Cheng , ZHAN Haibo ,  LIU Chao

Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, P. R. China;

Corresponding author：

LIU Chao, Email: liubeilun@me.com

Keywords：

Myocardial infarction; ventricular septal rupture; surgery; prognosis

DOI：

10.7507/1007-4848.202110043

Video：

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Objective To investigate the effect and prognosis of patients with ventricular septal rupture after myocardial infarction treated by surgical repair combining an occluder and a patch. Methods Clinical data of 42 patients with myocardial infarction complicated with ventricular septal rupture admitted to the First Affiliated Hospital of Zhengzhou University from January 2010 to September 2021 were retrospectively analyzed. According to the surgical methods, 27 patients were divided into a traditional group, including 17 males and 10 females, with an average age of 62.81±6.81 years, who were repaired by patch only, and 15 patients were divided into a modified group, including 11 males and 4 females, with an average age of 64.27±9.24 years, who were repaired by surgery combining an occluder and a patch. Perioperative and follow-up data of the two groups were compared and analyzed.Results There were statistical differences between the two groups in preoperative Killip grading, rate of intra-aortic balloon pump use, interval from myocardial infarction to operation, and the number of culprit artery (P<0.05). There was no statistical difference in other preoperative data, the cardiopulmonary bypass time, aortic cross-clamping time, postoperative hospital stay or in-hospital death rate between the two groups (P＞0.05). No residual shunt occurred in the modified group, and the difference was statistically significant compared with the traditional group (P=0.038). There was no statistical difference in other complications between the two groups (P＞0.05). The median follow-up time was 4 years. Two patients in the traditional group and one in the modified group died during follow-up. The follow-up cardiac function grading of patients in the modified group was statistically different from that in the traditional group (P=0.023). Conclusion The perioperative mortality of ventricular septal rupture after myocardial infarction is high, but the long-term effect is satisfactory. Surgical repair combining an occluder and a patch is a safe and effective treatment for ventricular septal rupture, which can effectively reduce postoperative residual shunt.

Citation： ZHOU Jiawei, YAO Xingxing, SUN Fuqiang, GUO Bowen, ZOU Cheng, ZHAN Haibo, LIU Chao. Clinical results of surgical repair combining an occluder and a patch for ventricular septal rupture after myocardial infarction. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(3): 416-421. doi: 10.7507/1007-4848.202110043 Copy

1.	Moreyra AE, Huang MS, Wilson AC, et al. Trends in incidence and mortality rates of ventricular septal rupture during acute myocardial infarction. Am J Cardiol, 2010, 106(8): 1095-1100.
2.	Goldsweig AM, Wang Y, Forrest JK, et al. Ventricular septal rupture complicating acute myocardial infarction: Incidence, treatment, and outcomes among medicare beneficiaries 1999-2014. Catheter Cardiovasc Interv, 2018, 92(6): 1104-1115.
3.	Arnaoutakis GJ, Zhao Y, George TJ, et al. Surgical repair of ventricular septal defect after myocardial infarction: Outcomes from the Society of Thoracic Surgeons National Database. Ann Thorac Surg, 2012, 94(2): 436-443.
4.	Papadopoulos N, Moritz A, Dzemali O, et al. Long-term results after surgical repair of postinfarction ventricular septal rupture by infarct exclusion technique. Ann Thorac Surg, 2009, 87(5): 1421-1425.
5.	Deja MA, Szostek J, Widenka K, et al. Post infarction ventricular septal defect—Can we do better? Eur J Cardiothorac Surg, 2000, 18(2): 194-201.
6.	Liu C, Xiao LL, Wang L, et al. A new surgical technique for post-myocardial infarction ventricular septal rupture with hemodynamic instability. Chin Med J (Engl), 2021, 134(8): 981-983.
7.	Xue X, Kan J, Zhang JJ, et al. Comparison in prevalence, predictors, and clinical outcome of VSR versus FWR after acute myocardial infarction: The prospective, multicenter registry MOODY trial-heart rupture analysis. Cardiovasc Revasc Med, 2019, 20(12): 1158-1164.
8.	Singh V, Rodriguez AP, Bhatt P, et al. Ventricular septal defect complicating ST-elevation myocardial infarctions: A call for action. Am J Med, 2017, 130(7): 863.e1-863.e12.
9.	Jones BM, Kapadia SR, Smedira NG, et al. Ventricular septal rupture complicating acute myocardial infarction: A contemporary review. Eur Heart J, 2014, 35(31): 2060-2068.
10.	Li H, Zhang S, Yu M, et al. Profile and outcomes of surgical treatment for ventricular septal rupture in patients with shock. Ann Thorac Surg, 2019, 108(4): 1127-1132.
11.	Ronco D, Matteucci M, Ravaux JM, et al. Mechanical circulatory support as a bridge to definitive treatment in post-infarction ventricular septal rupture. JACC Cardiovasc Interv, 2021, 14(10): 1053-1066.
12.	邹以席, 黄方炯. 急性心肌梗死并发室间隔穿孔患者的手术时机与评价. 中国胸心血管外科临床杂志, 2011, 18(5): 453-456.
13.	O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2013, 61(4): 485-510.
14.	Isoda S, Osako M, Kimura T, et al. Surgical repair of postinfarction ventricular septal defects—2013 update. Ann Thorac Cardiovasc Surg, 2013, 19(2): 95-102.
15.	Lundblad R, Abdelnoor M. Surgery of postinfarction ventricular septal rupture: The effect of David infarct exclusion versus Daggett direct septal closure on early and late outcomes. J Thorac Cardiovasc Surg, 2014, 148(6): 2736-2742.
16.	Matteucci M, Ronco D, Corazzari C, et al. Surgical repair of postinfarction ventricular septal rupture: Systematic review and meta-analysis. Ann Thorac Surg, 2021, 112(1): 326-337.
17.	Tang L, Fang Z, Hu X, et al. Non-surgical repair of ventricular septal rupture after acute myocardial infarction. Int J Cardiol, 2015, 185: 328-332.
18.	Giblett JP, Jenkins DP, Calvert PA. Transcatheter treatment of postinfarct ventricular septal defects. Heart, 2020, 106(12): 878-884.
19.	Kinoshita T, Asai T, Hachiro K, et al. Extended sandwich patch technique via right ventriculotomy for acute ventricular septal rupture. Ann Thorac Surg, 2021, S0003-4975(21): 00883-3.
20.	倪宇晴, 唐建军, 台适, 等. 急性心肌梗死合并室间隔穿孔早期死亡相关因素分析. 中华心血管病杂志, 2018, 46(12): 981-986.
21.	Pang PY, Sin YK, Lim CH, et al. Outcome and survival analysis of surgical repair of post-infarction ventricular septal rupture. J Cardiothorac Surg, 2013, 8: 44.
22.	Takahashi H, Arif R, Almashhoor A, et al. Long-term results after surgical treatment of postinfarction ventricular septal rupture. Eur J Cardiothorac Surg, 2015, 47(4): 720-724.

1. Moreyra AE, Huang MS, Wilson AC, et al. Trends in incidence and mortality rates of ventricular septal rupture during acute myocardial infarction. Am J Cardiol, 2010, 106(8): 1095-1100.
2. Goldsweig AM, Wang Y, Forrest JK, et al. Ventricular septal rupture complicating acute myocardial infarction: Incidence, treatment, and outcomes among medicare beneficiaries 1999-2014. Catheter Cardiovasc Interv, 2018, 92(6): 1104-1115.
3. Arnaoutakis GJ, Zhao Y, George TJ, et al. Surgical repair of ventricular septal defect after myocardial infarction: Outcomes from the Society of Thoracic Surgeons National Database. Ann Thorac Surg, 2012, 94(2): 436-443.
4. Papadopoulos N, Moritz A, Dzemali O, et al. Long-term results after surgical repair of postinfarction ventricular septal rupture by infarct exclusion technique. Ann Thorac Surg, 2009, 87(5): 1421-1425.
5. Deja MA, Szostek J, Widenka K, et al. Post infarction ventricular septal defect—Can we do better? Eur J Cardiothorac Surg, 2000, 18(2): 194-201.
6. Liu C, Xiao LL, Wang L, et al. A new surgical technique for post-myocardial infarction ventricular septal rupture with hemodynamic instability. Chin Med J (Engl), 2021, 134(8): 981-983.
7. Xue X, Kan J, Zhang JJ, et al. Comparison in prevalence, predictors, and clinical outcome of VSR versus FWR after acute myocardial infarction: The prospective, multicenter registry MOODY trial-heart rupture analysis. Cardiovasc Revasc Med, 2019, 20(12): 1158-1164.
8. Singh V, Rodriguez AP, Bhatt P, et al. Ventricular septal defect complicating ST-elevation myocardial infarctions: A call for action. Am J Med, 2017, 130(7): 863.e1-863.e12.
9. Jones BM, Kapadia SR, Smedira NG, et al. Ventricular septal rupture complicating acute myocardial infarction: A contemporary review. Eur Heart J, 2014, 35(31): 2060-2068.
10. Li H, Zhang S, Yu M, et al. Profile and outcomes of surgical treatment for ventricular septal rupture in patients with shock. Ann Thorac Surg, 2019, 108(4): 1127-1132.
11. Ronco D, Matteucci M, Ravaux JM, et al. Mechanical circulatory support as a bridge to definitive treatment in post-infarction ventricular septal rupture. JACC Cardiovasc Interv, 2021, 14(10): 1053-1066.
12. 邹以席, 黄方炯. 急性心肌梗死并发室间隔穿孔患者的手术时机与评价. 中国胸心血管外科临床杂志, 2011, 18(5): 453-456.
13. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2013, 61(4): 485-510.
14. Isoda S, Osako M, Kimura T, et al. Surgical repair of postinfarction ventricular septal defects—2013 update. Ann Thorac Cardiovasc Surg, 2013, 19(2): 95-102.
15. Lundblad R, Abdelnoor M. Surgery of postinfarction ventricular septal rupture: The effect of David infarct exclusion versus Daggett direct septal closure on early and late outcomes. J Thorac Cardiovasc Surg, 2014, 148(6): 2736-2742.
16. Matteucci M, Ronco D, Corazzari C, et al. Surgical repair of postinfarction ventricular septal rupture: Systematic review and meta-analysis. Ann Thorac Surg, 2021, 112(1): 326-337.
17. Tang L, Fang Z, Hu X, et al. Non-surgical repair of ventricular septal rupture after acute myocardial infarction. Int J Cardiol, 2015, 185: 328-332.
18. Giblett JP, Jenkins DP, Calvert PA. Transcatheter treatment of postinfarct ventricular septal defects. Heart, 2020, 106(12): 878-884.
19. Kinoshita T, Asai T, Hachiro K, et al. Extended sandwich patch technique via right ventriculotomy for acute ventricular septal rupture. Ann Thorac Surg, 2021, S0003-4975(21): 00883-3.
20. 倪宇晴, 唐建军, 台适, 等. 急性心肌梗死合并室间隔穿孔早期死亡相关因素分析. 中华心血管病杂志, 2018, 46(12): 981-986.
21. Pang PY, Sin YK, Lim CH, et al. Outcome and survival analysis of surgical repair of post-infarction ventricular septal rupture. J Cardiothorac Surg, 2013, 8: 44.
22. Takahashi H, Arif R, Almashhoor A, et al. Long-term results after surgical treatment of postinfarction ventricular septal rupture. Eur J Cardiothorac Surg, 2015, 47(4): 720-724.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical results of surgical repair combining an occluder and a patch for ventricular septal rupture after myocardial infarction

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