Surgical treatment of postinfarction ventricular septal defect: Lessons from our results

Aim: Post-infarction ventricular septal defect is the most serious complication resulting in high mortality. This occurs in 0.2 – 0.5% of cases. With conservative therapy, according to the reviewed literature, the mortality rate is approximately 90 – 100%. The only effective treatment for post-infarction ventricular septal defect is surgical repair.

Material and Methods: From 2002 to 2018, retrospective analysis was performed on 77 patients who underwent surgery for this pathology. The median age of the patients was 59.9±9.59 years. Out of these patients, 55 (72.2%) are men and 22 (27.7%) are women. 15 (16.6%) patients were smokers, 31 (34.4%) patients were diabetic and 70 (77.7%) patients had hypertension. The median fraction was 43.9±10.4%. One coronary artery in 18 (20%) patients, 2 blood vessels in 32 (35.5%) patients, and 3 blood vessel tears in 40 (44.4%) patients. In our study group, 14 (15.6%) patients underwent emergency surgery after hospitalization. Within the first three days – 21 (23.3%) patients, and then within the week – 19 (21.1%) patients. On average, after admission to the hospital the operation was performed within 7.8±7.7. 9 and (10%) patients were fitted with an intra-aortic balloon counter pulsator (IABP). Out of the 90 patients, 83 (92.2%) underwent surgery, and in 6 of the patients the peritoneal wall defect was removed by percutaneous means. Aorto-coronary bypass surgery was performed in parallel with 76 (91.6%) patients, the average number was 2.1±1.0 shunts. The left internal carotid artery was used in 6 (7.2%) patients. 1 (1.2%) patient had a mitral valve replacement. Left ventricular ventriculostomy was performed by the Daggett method in 45 (54.2%) patients and by the David method in 31 (37.3%) patients.

Results: The 30-day mortality in our group was 25.9%, and according to the literature, it occurs in 34-37%, although some authors mention 19-25%. Outcomes are influenced by factors such as cardiogenic shock and the ejection of the part of the heart. Also, in our group, survival rates are higher in patients who underwent long- term surgery two weeks after the onset of ventricular septal defect associated with the formation of fibrous tissue along the periphery of the necrotic site of myocardial infarction.

Conclusion: As for the concomitant coronary artery bypass grafting in our patients, no significant effect was observed in the early postoperative period.