CABG outcomes in patients with postinfarctional ventricular septal rupture

Aim: Postinfarctional ventricular septal rupture (Post MI VSR) is the most fatal complication of the myocardial infarction. The mortality rate in modern and in-time surgical management is varying between 10 and 40%; the survival rate is 88% in the first year. The issue of CABG (coronary artery by-pass grafting) is still the subject of great discussion. In order to clarify this issue, we decided to analyze the short- and long-term outcomes of CABG in our patients with Post MI VSR.

Material and Methods: In our research we analyzed 90 patients with IHD (ischemic heart disease), complicated with Post-MI IVS rupture (Post -MI IVSR). Most of the patients with Post MI VSR were over 60 years old. The Post MI VSR within first days after acute myocardial infarction (AMI) was detected in 10 patients; up to 3 days – in 6 patients; up to 7 days – in 3 patients; from 7 to 29 days – in 4 patients. The time of IVS rupture after AMI was varying from 1 to 29 days (5.5±7.6 дней). All patients were distributed into groups depending on the hospitalization time after AMI.

Out of 83 patients underwent reconstruction after Post MI VSR, 79 (95.2%) required CABG. Two- or three-vessel lesions were detected in 67 (80.7%) patients. Cumulative mortality in CABG group was 19.7%, whereas in the group without accompanied CABG – 20%. The long-term outcomes were followed from 1- to 8 years, averagely in 18 patients (28.6%).

Results: The decompensation of heart failure and relapse of coronary symptoms during follow-up up to 3 years was observed in 6 (33.3%) patients, during follow-up from 3 to 8 years – in 3 (25%) out of 12 patients. The repeated revascularization was conducted in 5 patients.

Conclusion: Our results are showing the benefits of CABG in patients with Post MI VSR, which requires mandatory coronary angiography in pre-op period.