Surgical Treatment of Postinfarction Ventricular Septal Rupture

Ventricular septal rupture (VSR) is a rare but life-threatening mechanical complication of acute myocardial infarction associated with high mortality despite prompt treatment. Surgery represents the standard of care; however, only small single-center series or national registries are usually availab...

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Published in:JAMA network open 2021-10, Vol.4 (10), p.e2128309-e2128309
Main Authors: Ronco, Daniele, Matteucci, Matteo, Kowalewski, Mariusz, De Bonis, Michele, Formica, Francesco, Jiritano, Federica, Fina, Dario, Folliguet, Thierry, Bonaros, Nikolaos, Russo, Claudio Francesco, Sponga, Sandro, Vendramin, Igor, De Vincentiis, Carlo, Ranucci, Marco, Suwalski, Piotr, Falcetta, Giosuè, Fischlein, Theodor, Troise, Giovanni, Villa, Emmanuel, Dato, Guglielmo Actis, Carrozzini, Massimiliano, Serraino, Giuseppe Filiberto, Shah, Shabir Hussain, Scrofani, Roberto, Fiore, Antonio, Kalisnik, Jurij Matija, D'Alessandro, Stefano, Lodo, Vittoria, Kowalówka, Adam R, Deja, Marek A, Almobayedh, Salman, Massimi, Giulio, Thielmann, Matthias, Meyns, Bart, Khouqeer, Fareed A, Al-Attar, Nawwar, Pozzi, Matteo, Obadia, Jean-François, Boeken, Udo, Kalampokas, Nikolaos, Fino, Carlo, Simon, Caterina, Naito, Shiho, Beghi, Cesare, Lorusso, Roberto
Format: Article
Language:English
Subjects:
Aged
Cohort Studies
Coronary Artery Bypass - methods
Coronary Artery Bypass - statistics & numerical data
Extracorporeal membrane oxygenation
Female
Heart attacks
Humans
Life Sciences
Male
Middle Aged
Mortality
Myocardial Infarction - complications
Odds Ratio
Online Only
Original Investigation
Prospective Studies
Retrospective Studies
Surgery
Ventricular Septal Rupture - etiology
Ventricular Septal Rupture - surgery
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Summary:Ventricular septal rupture (VSR) is a rare but life-threatening mechanical complication of acute myocardial infarction associated with high mortality despite prompt treatment. Surgery represents the standard of care; however, only small single-center series or national registries are usually available in literature, whereas international multicenter investigations have been poorly carried out, therefore limiting the evidence on this topic. To assess the clinical characteristics and early outcomes for patients who received surgery for postinfarction VSR and to identify factors independently associated with mortality. The Mechanical Complications of Acute Myocardial Infarction: an International Multicenter Cohort (CAUTION) Study is a retrospective multicenter international cohort study that includes patients who were treated surgically for mechanical complications of acute myocardial infarction. The study was conducted from January 2001 to December 2019 at 26 different centers worldwide among 475 consecutive patients who underwent surgery for postinfarction VSR. Surgical treatment of postinfarction VSR, independent of the technique, alone or combined with other procedures (eg, coronary artery bypass grafting). The primary outcome was early mortality; secondary outcomes were postoperative complications. Of the 475 patients included in the study, 290 (61.1%) were men, with a mean (SD) age of 68.5 (10.1) years. Cardiogenic shock was present in 213 patients (44.8%). Emergent or salvage surgery was performed in 212 cases (44.6%). The early mortality rate was 40.4% (192 patients), and it did not improve during the nearly 20 years considered for the study (median [IQR] yearly mortality, 41.7% [32.6%-50.0%]). Low cardiac output syndrome and multiorgan failure were the most common causes of death (low cardiac output syndrome, 70 [36.5%]; multiorgan failure, 53 [27.6%]). Recurrent VSR occurred in 59 participants (12.4%) but was not associated with mortality. Cardiogenic shock (survived: 95 [33.6%]; died, 118 [61.5%]; P 
ISSN:2574-3805
2574-3805
DOI:10.1001/jamanetworkopen.2021.28309