Document Detail


Determinants of in-hospital and long-term surgical outcomes after repair of postinfarction ventricular septal rupture.
MedLine Citation:
PMID:  19919868     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Surgical repair of post-myocardial infarction ventricular septal rupture is challenging with reported early mortality being substantial. In addition, congestive cardiac failure and ventricular tachyarrhythmia frequently occur long term after the operation, although frequency and predictive factors of these events have been poorly identified. METHODS: A consecutive series of 68 patients who underwent repair of postinfarction ventricular septal rupture by 14 surgeons between 1988 and 2007 was studied. Fifty-eight (85%) patients underwent repair in an urgent setting (<48 hours after diagnosis). Coronary artery bypass grafting was concomitantly performed in 48 (71%) patients. Mean follow-up period was 9.2 +/- 4.9 years. RESULTS: Thirty-day mortality was 35%, with previous myocardial infarction, previous cardiac surgery, preoperative left ventricular ejection fraction less than 40%, and urgent surgery being independent risk factors. Actuarial survival of 30-day survivors was 88% at 5 years, 73% at 10 years, and 51% at 15 years. Actuarial freedom from congestive cardiac failure and ventricular tachyarrhythmia was 70% and 85% at 5 years, 54% and 71% at 10 years, and 28% and 61% at 15 years, respectively. Independent predictors for congestive cardiac failure included hypertension, posterior septal rupture, residual interventricular communication, and preoperative left ventricular ejection fraction less than 40%, whereas concomitant ventricular aneurysmectomy and preoperative occlusion of the left anterior descending artery were independent predictors of ventricular tachyarrhythmia. CONCLUSIONS: Long-term outcomes after surgical repair of postinfarction ventricular septal rupture was favorable, despite infrequent exposure by individual surgeons to the pathologic features, indicating that an aggressive surgical approach is warranted. Predictors of congestive cardiac failure and ventricular arrhythmia long term varied.
Authors:
Satsuki Fukushima; Peter J Tesar; Homayoun Jalali; Andrew J Clarke; Hemant Sharma; Jivesh Choudhary; Harry Bartlett; Peter G Pohlner
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Publication Detail:
Type:  Journal Article     Date:  2009-11-17
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  140     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-12     Completed Date:  2010-08-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  59-65     Citation Subset:  AIM; IM    
Copyright Information:
Crown Copyright 2010. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, QLD 4032, Australia. Satsuki_Fukushima@health.qld.gov.au
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiac Surgical Procedures* / adverse effects,  mortality
Chi-Square Distribution
Female
Heart Failure / etiology
Hospital Mortality
Humans
Kaplan-Meiers Estimate
Logistic Models
Male
Middle Aged
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Risk Factors
Tachycardia, Ventricular / etiology
Time Factors
Treatment Outcome
Ventricular Septal Rupture / mortality,  surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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