Outcomes Of Postinfarct Ventricular Septal Rapture
Fumiya Chubachi, Hiroyuki Nakajima, Tomomi Nakajima, Akitoshi Takazawa, Osamu Kinoshita, Akihiro Yoshitake, Toshihisa Asakura.
Saitama medical university Internatinal medical center, Hidaka, Japan.
BACKGROUND:ostinfarct ventricular septal rupture (VSR) is a life-threatening complication which usually requires emergent surgery. Although VSR can be repaired via either left and right ventriculotomy, recently we select right ventriculotomy to avoid postoperative left ventricular dysfunction. In this study, early and long-term results were examined according to two treatment methods.
METHODS:etween January 2010 to June 2022, 32 patients underwent emergency surgery for postinfarct VSR at our institution. 17(53.1%) was male and the age at the operation was 71.3±9.5 years. The location of VSD was anteroapical in 18 patients and inferior in 14 patients. Of these, LV group consist of 22 patients, who underwent repair with infarct exclusion using xenopericardial patch via left ventriculotomy, while RV group consist of 12 underwent repair via right ventriculotomy. Preoperative PCPS insertion was 3 (13.6%) in the LV group and 2 (20%) in the RV group (p=0.6125). culprit coronary lesion was interior descending artery in 20 patients, and right coronary artery in 12 patients. There was no significant difference in the age, gender, location of VSD between the two groups. The mean follow-up period was 820±167 days.
RESULTS:There was no significant difference in preoperative ejection fraction on echocardiography (48±13 vs. 54±16, p=0.1858). Cardiac arrest time was relatively shorter in the RV group (160±38 vs. 124±39, p=0.020). Although there was no statistically significant difference, operative time tended to be also shorter in the RV group, even in cases of inferior wall perforation.In the early results, there were 5 hospital deaths of multiple organ dysfunction or sepsis (3 in the LV group and 2 in the RV group). Postoperative circulatory support was required in 2 patients of LV group, and they were survived. Reoperation was performed in 3 patients of LV group and 2 patients of RV group for residual shunt. Papillary muscle rupture occurred in 1 patient of RV group. There were no significant differences in postoperative complications such as respiratory complications, hemodialysis, cerebral infarction, residual shunt, and valvular disease.Three deaths occurred during long-term observation. Reoperation for mobile thrombus in the left ventricle for 1 patient in the LV group. residual shunt was detected in 13 patients in LV group and 4 patients in RV group (p=0.743). Kaplan-Meier survival rate was 75% at 1 year, with no difference (72% vs. 80%, p=0.750). CONCLUSIONS:Long-term survival can be highly expected for hospital survivors of VSR. Surgical repair via RV reduces cardiac arrest time and operative time, and there was no increase in leakage over time. Furthermore, the risk of thrombus formation in the left ventricle could be minimized. 
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