Document Detail


Surgical repair of post infarction ventricular septal defects: a national experience.
MedLine Citation:
PMID:  15691673     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Ventricular septal rupture is a rare but feared complication after acute myocardial infarction. Most reports about outcome after surgical treatment are single center experiences. We investigated the results after surgical repair in all patients in Sweden during a 7-year period. METHODS: All patients undergoing surgical repair 1992-1998 were identified with the aid of the Swedish Heart Surgery Registry. The patients (n=189, 63% men, mean age 69+/-8 years) were operated at 10 different centers. Pre-and peri-operative variables were collected from the Registry and individual patient charts. Mortality was calculated and a Cox proportional hazards regression model was used to identify independent predictors for early and late mortality. Mean follow-up was 2.4 years. RESULTS: Seventy-seven of the 189 patients died within 30 days (41%). Urgent repair (Risk Ratio 4.2 (2.0-8.9), P<0.001) and posterior rupture (RR 2.1 (1.3-3.4), P=0.002) were independent predictors of 30-day mortality. Total cumulative survival (Kaplan-Meyer) was 38% at 5 years. For patients that survived the first 30 days (n=112), 5 year cumulative survival was 67%. Independent predictors for mortality after 30 days were number of concomitant coronary anastomoses (RR 1.5 (1.2-2.0), P=0.001), residual postoperative shunt (RR 2.7 (1.4-5.4), P=0.004) and postoperative dialysis (RR 3.4 (1.5-7.5), P=0.003). CONCLUSIONS: Early mortality after surgical repair of post infarction septal rupture is still considerable. Early repair and posterior rupture are predictors of early mortality. Long-term survival in patients surviving the immediate postoperative period is limited by pre-existing coronary artery disease, postoperative renal failure and the presence of a residual postoperative shunt.
Authors:
Anders Jeppsson; Hans Liden; Per Johnsson; Marianne Hartford; Kjell Rådegran
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  27     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2005 Feb 
Date Detail:
Created Date:  2005-02-04     Completed Date:  2005-05-24     Revised Date:  2005-10-17    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  216-21     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden. anders.jeppsson@vgregion.se
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MeSH Terms
Descriptor/Qualifier:
Aged
Anastomosis, Surgical / methods
Coronary Angiography / methods
Coronary Artery Bypass
Female
Heart Rupture, Post-Infarction / surgery
Heart Septal Defects, Ventricular / etiology,  mortality,  surgery*
Humans
Male
Multivariate Analysis
Myocardial Infarction / complications*,  mortality,  radiography
Postoperative Complications / etiology
Preoperative Care / methods
Risk Assessment / methods
Survival Analysis
Time Factors
Treatment Outcome
Comments/Corrections
Comment In:
Eur J Cardiothorac Surg. 2005 Jul;28(1):185-6; author reply 186-7   [PMID:  15939597 ]

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


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