Little change in prognosis for ventricular septal rupture

Ventricular septal rupture is a rare but potentially fatal complication of myocardial infarction. Current ACC and AHA guidelines recommend immediate operative intervention in patients with postinfarction ruptures, regardless of their clinical status, but surgical repair remains very challenging with reported in-hospital mortality being in the range of 20-60%.

In this single-centre retrospective study, the authors identified a total of 68 patients undergoing repair between 1988 and 2007 (out of a total of 37 177 cardiac surgical procedures during this time). The majority (85%) were operated on within 48 h of diagnosis and 96% had preceding coronary angiography and 71% subsequent surgical revascularisation with an average of 1.7 grafts per case. A total of 14 surgeons were responsible for the operations and approaches and techniques differed but 99% had repair using a patch either of artificial material (74%), bovine pericardium (22%) or autologous pericardium (3%). A minority of patients also underwent a variety of other procedures including LV aneurysmectomy (6%) and mitral valve surgery (1%). The mean follow-up period was 9.2 ± 4.9 years.

Thirty-day mortality for the whole group was 35%, with previous myocardial infarction, previous cardiac surgery, preoperative left ventricular ejection fraction less than 40%, and urgent surgery being independent risk factors for death. However, in the group who presented with cardiogenic shock (12%) 30-day mortality was 100%. On the other hand, in those who survived 30 days, prognosis was good with an actuarial survival of 88% at 5 years, 73% at 10 years, and 51% at 15 years (see figure). Actuarial freedom from congestive cardiac failure and ventricular tachyarrhythmia was also good at 70% and 85% at 5 years, 54% and 71% at 10 years, and 28% and 61% at 15 years, respectively.

Interestingly, despite the long period of the study and the evolution in surgical techniques and technology over time, …