Surgical efficacy of anterior or posterior ventricular septal rupture in patients with myocardial infarction
10.3760/cma.j.cn112434-20191229-00462
- VernacularTitle:心肌梗死合并前或后间隔穿孔的外科疗效分析
- Author:
Yang ZHAO
1
;
Wei FU
;
Xiaolong MA
;
Zhuhui HUANG
;
Taoshuai LIU
;
Ran DONG
Author Information
1. 首都医科大学附属北京安贞医院心脏外科 100029
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2020;36(5):291-295
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical characteristics and outcomes of patients with myocardial infarction(MI) accompanied by ventricular septal rupture(VSR) at anterior versus inferior septum.Methods:Sixty patients with MI and VSR who had been treated by surgery between January 2009 and December 2018 were selected for a retrospective study, and allocated into either anterior septal group(AS group, n=43) or inferior septal group(IS group, n=17) based on the VSR site. The primary outcomes included major adverse cardiovascular events(MACCEs), cardiac death, MI, heart failure(HF), stroke and revascularization, with a median follow-up of 4.94 years.Results:There were 8 cases died in the perioperation, including 6 patients in the AS group, 1 case for gastrointestinal bleeding after using the extracorporeal membrane lung, 2 cases for low cardiac output after the second thoracotomy exploration and 3 for postoperative pulmonary infection. While in the IS group 2 patients died, 1 for low cardiac output after the second thoracotomy exploration and 1 for postoperative heart failure. Compared with those in IS group, patients of AS group were more likely to be composed of male patients(44.2% vs 11.8%, P=0.019), with low left ventricular ejection fraction(0.47±0.09 vs 0.56±0.06, P=0.001), shorter interval from MI to operation[(52.9±35.3)days vs(79.6±65.1)days, P=0.045], shorter CPB time[(137.9±48.6)min vs(169.9±42.3)min, P=0.024], shorter cross-clamp time[(82.4±32.1)min vs(107.0±30.4)min, P=0.011], and lower postoperative LVEDD[(49.1±5.7)mm vs.(52.9±4.8)mm, P=0.029]. There was no difference in perioperative complications between the two groups(including in hospital death, HF, ventricular fibrillation, pericardial tamponade and secondary thoracotomy). Additionally, long-term follow-up showes that there was also no difference in MACCEs, death, MI, HF, stroke and revascularization between the two groups( P>0.05). Conclusion:The perioperative risk and outcomes of surgery for MI patients with AS or IS are similar.
