Our Results of Surgical Repair of Postinfarction Ventricular Septal Rupture: Analysis of Variables Affecting Mortality and Morbidity

Postinfarction ventricular septal defect (VSR) developing in 1-2% of patients is a serious complication with high mortality rates. In this study, VSRs repaired surgically were evaluated retrospectively with clinical and echocardiographic findings to analyse variables affecting mortality and morbidity as well as surgical technique. The preoperative, perioperative, and postoperative early and mid-term follow-up data of 21 patients with VSR who underwent surgical repair from 1996 through 2001, were evaluated. Preoperative coronary angiography, cardiac catheterization were performed in all patients. Preoperative and postoperative control echocardiography were also performed in all patients but two patients who died perioperatively. Follow-up data after the discharge of these patients were obtained via monthly periodical examinations in the first 6 months, and thereafter via telephone interviews. The mean follow-up time of surviving 13 patients was 27.62±22.60 (2-67) months. Overall mortality and early mortality rates were 42.9% and 38.1%, respectively. Postoperative complications were observed in 13 (68.4%) patients. The most frequently encountered complication was congestive heart failure developed in 8 patients. Advanced age and cardiogenic shock were significant risk factors for postoperative renal failure and congestive heart failure. Overall morbidity was significantly high in patients with preoperative QP/QS>2. Advanced age, anterior MI, ejection fraction (LVEF)<40%, anterior VSR, and single-patch repair technique used to repair anterior VSR were found to be the determinants of mortality. Despite the improved surgical techniques, postinfarction ventricular septal defect with extensive myocardial damage still continues to be a very difficult surgical challenge with high mortality rates.