Document Detail


Transcatheter Closure of Post-myocardial Infarction Ventricular Septal Rupture.
MedLine Citation:
PMID:  23339839     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: VENTRICULAR SEPTAL RUPTURE (VSR) AFTER ACUTE MYOCARDIAL INFARCTION (AMI) IS A POTENTIALLY LETHAL MECHANICAL COMPLICATION OF ACUTE CORONARY SYNDROMES. GIVEN HIGH SURGICAL MORTALITY, TRANSCATHETER CLOSURE HAS EMERGED AS A POTENTIAL STRATEGY IN SELECTED CASES. WE REPORT OUR SINGLE-CENTER EXPERIENCE WITH DOUBLE-UMBRELLA DEVICE PERCUTANEOUS CLOSURE OF POST-AMI VSR.METHODS AND RESULTS: IN THIS SINGLE-CENTER, RETROSPECTIVE, COHORT STUDY, PATIENTS WHO UNDERWENT TRANSCATHETER CLOSURE OF POST-AMI VSR BETWEEN 1988 AND 2008 AT BOSTON CHILDRENS HOSPITAL WERE INCLUDED. DATA WERE ANALYSED ACCORDING TO WHETHER THE PATIENTS UNDERWENT DIRECT PERCUTANEOUS VSR CLOSURE OR CLOSURE OF A RESIDUAL VSR AFTER A PREVIOUS SURGICAL APPROACH. PRIMARY OUTCOME WAS MORTALITY RATE AT 30 DAYS. CLINICAL PREDICTORS OF PRIMARY OUTCOME WERE INVESTIGATED USING UNIVARIATE LOGISTIC REGRESSION. THIRTY PATIENTS WERE INCLUDED IN THE STUDY (MEAN AGE, 678 YEARS). A TOTAL OF 40 CLOSURE DEVICES WERE IMPLANTED. MAJOR PERIPROCEDURAL COMPLICATIONS OCCURRED IN 4 (13%) PATIENTS. CARDIOGENIC SHOCK, INCREASING PULMONARY/SYSTEMIC FLOW RATIO, AND THE USE OF THE NEW GENERATION (6-ARM) STARFLEX DEVICE ALL WERE ASSOCIATED WITH HIGHER RISK OF MORTALITY. THE MODEL FOR END-STAGE LIVER DISEASE EXCLUDING INTERNATIONAL NORMALIZED RATIO (MELD-XI) SCORE AT THE TIME OF VSR CLOSURE SEEMED TO BE MOST STRONGLY ASSOCIATED WITH DEATH (ODDS RATIO, 1.6; CONFIDENCE INTERVAL, 1.12.2; P0.001).CONCLUSIONS: Transcatheter closure of post-AMI VSR using CardioSEAL or STARFlex devices is feasible and effective. The MELD-XI score, a marker of multiorgan dysfunction, is a promising risk stratifier in this population of patients. Early closure of post-AMI VSR is advisable before establishment of multiorgan failure.
Authors:
Gabriele Egidy Assenza; Doff B McElhinney; Anne Marie Valente; Disty D Pearson; Massimo Volpe; Giuseppe Martucci; Michael J Landzberg; James E Lock
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-22
Journal Detail:
Title:  Circulation. Cardiovascular interventions     Volume:  -     ISSN:  1941-7632     ISO Abbreviation:  Circ Cardiovasc Interv     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101499602     Medline TA:  Circ Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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