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open access

Vol 29, No 5 (2022)
Original Article
Submitted: 2021-09-09
Accepted: 2021-11-24
Published online: 2022-05-13
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Optimal surgical timing after post-infarction ventricular septal rupture

Juan Diego Sánchez Vega1, Gonzalo Luis Alonso Salinas12, José María Viéitez Florez13, Albert Ariza Solé4, Esteban López de Sá56, Ricardo Sanz-Ruiz7, Virginia Burgos Palacios8, Sergio Raposeiras Roubin9, Susana Gómez Varela10, Juan Sanchís Forés11, Lorenzo Silva Melchor3, Xurxo Martínez-Seara12, Lorena Malagón López2, Ana Viana Tejedor13, Miguel Corbí Pascual14, José Luis Zamorano Gómez1, Marcelo Sanmartín-Fernández1
DOI: 10.5603/CJ.a2022.0035
·
Pubmed: 35578757
·
Cardiol J 2022;29(5):773-781.
Affiliations
  1. Department of Cardiology, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERCV, Madrid, Spain
  2. Department of Cardiology, Complejo Hospitalario de Navarra, Pamplona, Spain
  3. Department of Cardiology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
  4. Department of Cardiology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
  5. Department of Cardiology, Hospital Universitario La Paz, IDIPAZ, Madrid, Spain
  6. Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain, Spain
  7. Department of Cardiology, Hospital Universitario Gregorio Marañón, Madrid, Spain
  8. Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
  9. Department of Cardiology, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
  10. Department of Cardiology, Hospital Universitario de Cruces, Baracaldo, Sapin
  11. Department of Cardiology, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
  12. Department of Cardiology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
  13. Department of Cardiology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Clínico San Carlos, Madrid, Spain
  14. Department of Cardiology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain

open access

Vol 29, No 5 (2022)
Original articles — Clinical cardiology
Submitted: 2021-09-09
Accepted: 2021-11-24
Published online: 2022-05-13

Abstract

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.

Abstract

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.

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Keywords

ventricular septal rupture, acute myocardial infarction, cardiogenic shock, mechanical complications, extracorporeal membrane oxygenation

About this article
Title

Optimal surgical timing after post-infarction ventricular septal rupture

Journal

Cardiology Journal

Issue

Vol 29, No 5 (2022)

Article type

Original Article

Pages

773-781

Published online

2022-05-13

Page views

4585

Article views/downloads

735

DOI

10.5603/CJ.a2022.0035

Pubmed

35578757

Bibliographic record

Cardiol J 2022;29(5):773-781.

Keywords

ventricular septal rupture
acute myocardial infarction
cardiogenic shock
mechanical complications
extracorporeal membrane oxygenation

Authors

Juan Diego Sánchez Vega
Gonzalo Luis Alonso Salinas
José María Viéitez Florez
Albert Ariza Solé
Esteban López de Sá
Ricardo Sanz-Ruiz
Virginia Burgos Palacios
Sergio Raposeiras Roubin
Susana Gómez Varela
Juan Sanchís Forés
Lorenzo Silva Melchor
Xurxo Martínez-Seara
Lorena Malagón López
Ana Viana Tejedor
Miguel Corbí Pascual
José Luis Zamorano Gómez
Marcelo Sanmartín-Fernández

References (35)
  1. Bajaj A, Sethi A, Rathor P, et al. Acute complications of myocardial infarction in the current era: diagnosis and management. J Investig Med. 2015; 63(7): 844–855.
    CrossRefPubMed
  2. Elbadawi A, Elgendy IY, Mahmoud K, et al. Temporal trends and outcomes of mechanical complications in patients with acute myocardial infarction. JACC Cardiovasc Interv. 2019; 12(18): 1825–1836.
    CrossRefPubMed
  3. Contemporary Management of Post-MI Ventricular Septal Rupture - American College of Cardiology. Accessed January 12, 2021. https://www.acc.org/latest-in-cardiology/articles/2018/07/30/06/58/contemporary-management-of-post-mi-ventricular-septal-rupture.
  4. 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.
    CrossRefPubMed
  5. Puerto E, Viana-Tejedor A, Martínez-Sellés M, et al. Temporal trends in mechanical complications of acute myocardial infarction in the elderly. J Am Coll Cardiol. 2018; 72(9): 959–966.
    CrossRefPubMed
  6. Rab T, Ratanapo S, Kern KB, et al. Cardiac shock care centers: JACC review topic of the week. J Am Coll Cardiol. 2018; 72(16): 1972–1980.
    CrossRefPubMed
  7. Menon V, Webb JG, Hillis LD, et al. Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK? J Am Coll Cardiol. 2000; 36(3 Suppl A): 1110–1116.
    CrossRefPubMed
  8. Wayangankar SA, Bangalore S, McCoy LA, et al. Temporal trends and outcomes of patients undergoing percutaneous coronary interventions for cardiogenic shock in the setting of acute myocardial infarction: a report from the cathpci registry. JACC Cardiovasc Interv. 2016; 9(4): 341–351.
    CrossRefPubMed
  9. Bakhshi H, Gattani R, Ekanem E, et al. Ventricular septal rupture and cardiogenic shock complicating STEMI during COVID-19 pandemic: An old foe re-emerges. Heart Lung. 2021; 50(2): 292–295.
    CrossRefPubMed
  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.
    CrossRefPubMed
  11. Ciarka A, Edwards L, Nilsson J, et al. Trends in the use of mechanical circulatory support as a bridge to heart transplantation across different age groups. Int J Cardiol. 2017; 231: 225–227.
    CrossRefPubMed
  12. Murday A. Optimal management of acute ventricular septal rupture. Heart. 2003; 89(12): 1462–1466.
    CrossRefPubMed
  13. 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.
    CrossRefPubMed
  14. Sánchez Vega JD, Alonso Salinas GL, Viéitez Flórez JM, et al. Temporal trends in postinfarction ventricular septal rupture: the CIVIAM Registry. Rev Esp Cardiol (Engl Ed). 2021; 74(9): 757–764.
    CrossRefPubMed
  15. Ariza-Solé A, Sánchez-Salado JC, Sbraga F, et al. The role of perioperative cardiorespiratory support in post infarction ventricular septal rupture-related cardiogenic shock. Eur Heart J Acute Cardiovasc Care. 2020; 9(2): 128–137.
    CrossRefPubMed
  16. Papalexopoulou N, Young CP, Attia RQ. What is the best timing of surgery in patients with post-infarct ventricular septal rupture? Interact Cardiovasc Thorac Surg. 2013; 16(2): 193–196.
    CrossRefPubMed
  17. Goldberg SL, Don CW. The ongoing - and resurgent - challenge of post-infarct ventricular septal defect management. Cardiovasc Revasc Med. 2020; 21(9): 1097–1098.
    CrossRefPubMed
  18. Shafiei I, Jannati F, Jannati M. Optimal time repair of ventricular septal rupture post myocardial infarction. J Saudi Heart Assoc. 2020; 32(2): 288–294.
    CrossRefPubMed
  19. Schlotter F, de Waha S, Eitel I, et al. Interventional post-myocardial infarction ventricular septal defect closure: a systematic review of current evidence. EuroIntervention. 2016; 12(1): 94–102.
    CrossRefPubMed
  20. Calvert PA, Cockburn J, Wynne D, et al. Percutaneous closure of postinfarction ventricular septal defect: in-hospital outcomes and long-term follow-up of UK experience. Circulation. 2014; 129(23): 2395–2402.
    CrossRefPubMed
  21. Garg R, Yusuf S. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials. JAMA. 1995; 273(18): 1450–1456.
    PubMed
  22. El Sibai R, Bachir R, El Sayed M. ECMO use and mortality in adult patients with cardiogenic shock: a retrospective observational study in U.S. hospitals. BMC Emerg Med. 2018; 18(1): 20.
    CrossRefPubMed
  23. Ostadal P, Rokyta R, Kruger A, et al. Extra corporeal membrane oxygenation in the therapy of cardiogenic shock (ECMO-CS): rationale and design of the multicenter randomized trial. Eur J Heart Fail. 2017; 19 Suppl 2: 124–127.
    CrossRefPubMed
  24. Pascual I, López F, Hernández-Vaquero D, et al. Circulatory support with extracorporeal membrane oxygenation system as a bridge to heart transplantation in complex postinfarction ventricular septal rupture. Rev Esp Cardiol (Engl Ed). 2016; 69(6): 617–619.
    CrossRefPubMed
  25. Sun HY, Ko WJ, Tsai PR, et al. Infections occurring during extracorporeal membrane oxygenation use in adult patients. J Thorac Cardiovasc Surg. 2010; 140(5): 1125–32.e2.
    CrossRefPubMed
  26. Ihdayhid AR, Chopra S, Rankin J. Intra-aortic balloon pump: indications, efficacy, guidelines and future directions. Curr Opin Cardiol. 2014; 29(4): 285–292.
    CrossRefPubMed
  27. Hobbs R, Korutla V, Suzuki Y, et al. Mechanical circulatory support as a bridge to definitive surgical repair after post-myocardial infarct ventricular septal defect. J Card Surg. 2015; 30(6): 535–540.
    CrossRefPubMed
  28. 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.
    CrossRefPubMed
  29. Mubarik A, Iqbal AM. Ventricular Septal Rupture. [Updated 2021 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Published online January 2021. https://www.ncbi.nlm.nih.gov/books/NBK534857/.
  30. Wang Y, Bellomo R. Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment. Nat Rev Nephrol. 2017; 13(11): 697–711.
    CrossRefPubMed
  31. Cinq-Mars A, Voisine P, Dagenais F, et al. Risk factors of mortality after surgical correction of ventricular septal defect following myocardial infarction: Retrospective analysis and review of the literature. Int J Cardiol. 2016; 206: 27–36.
    CrossRefPubMed
  32. Lamb KM, Hirose H. Vascular complications in extracoporeal membrane oxygenation. Crit Care Clin. 2017; 33(4): 813–824.
    CrossRefPubMed
  33. Bonicolini E, Martucci G, Simons J, et al. Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation: a narrative review of incidence, prevention, monitoring, and treatment. Crit Care. 2019; 23(1): 266.
    CrossRefPubMed
  34. Thomas J, Kostousov V, Teruya J. Bleeding and thrombotic complications in the use of extracorporeal membrane oxygenation. Semin Thromb Hemost. 2018; 44(1): 20–29.
    CrossRefPubMed
  35. Tsangaris A, Alexy T, Kalra R, et al. Overview of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support for the management of cardiogenic shock. Front Cardiovasc Med. 2021; 8: 686558.
    CrossRefPubMed

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