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Ventricular septal rupture: insights into an old disease

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Abstract

Ventricular septal rupture (VSR) is a serious complication of ST-elevation myocardial infarction (STEMI) and surgery is the reference treatment. We aimed at describing trends in management and mortality during the last four decades and reporting mortality predictors in these patients. We conducted a single-center retrospective study of patients sustaining a VSR from 1981 to 2020. We screened 274 patients and included 265 for analysis. The number of patients decreased over the years: 80, 88, 56, and 50 in each 10-year time span. In-hospital mortality decreased significantly since 1990 (logrank 0.007). The median age was 72.0 years IQR [66–78] and 188 patients (70.9%) were operated on. IABP was used more routinely (p < 0.0001). In-hospital mortality was assessed at 66.8% (177 patients) and main predictors of death were a time from MI to surgery < 8 days HR 2.7 IC95% [1.9–3.8] p < 0.0001, a Killip class > 2 HR 2.5 IC [1.9–3.4] p < 0.0001 and Euroscore 2 > 20 HR 2.4 IC [1.8–3.2] p < 0.0001. A “time from MI to surgery” of 8 days offers the best ability to discriminate between patients with or without mortality. The ability of “Euroscore 2 and Killip” to detect the patients most likely to wait 8 days for surgery was at 0.81 [0.73–0.89] p < 0.0001. Mortality remains high over the years. Euroscore 2, Killip class, and time from MI to surgery are the main mortality predictors. Patients with a Killip < 3 and a Euroscore < 20 should be monitored at least 8 days since MI before being referred to surgery.

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Abbreviations

CABG:

Coronary artery bypass grafting

ECLS:

Extracorporeal life support

IABP:

Intra aortic balloon pump

MI:

Myocardial infarction

LVEF:

Left ventricular ejection fraction

VSR:

Ventricular septal rupture

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Cardiac Intensive Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France

    Ahmad Hayek, Léa Azar, Iyad Abou-Saleh, Héléna Simion, Danka Tomasevic, Cyril Prieur, Flora Kochly, Bertrand Scheppler, Eric Bonnefoy-Cudraz & Thomas Bochaton

  2. Claude Bernard University Lyon 1, Villeurbanne, France

    Ahmad Hayek, Léa Azar, Iyad Abou-Saleh, Héléna Simion, Danka Tomasevic, Cyril Prieur, Flora Kochly, Bertrand Scheppler, Gilles Rioufol, François Derimay, Nathan Mewton, Eric Bonnefoy-Cudraz & Thomas Bochaton

  3. Department of Cardiac Surgery, “Louis Pradel” Cardiologic Hospital, 28 Avenue du Doyen Lépine, 69500, Lyon, France

    Matteo Pozzi, Daniel Grinberg, Fadi Farhat & Jean-François Obadia

  4. Department of Cardiology and Interventional Cardiology, Hôpital Cardiologique Louis Pradel, Université Claude-Bernard, Inserm UMR 1060, Lyon, France

    Gilles Rioufol & François Derimay

  5. Centre d’investigation Clinique, Hôpital Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France

    Nathan Mewton

  6. INSERM U1060, CarMeN laboratory, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, 59 boulevard Pinel, 69500, Bron, France

    Ahmad Hayek & Thomas Bochaton

Authors
  1. Ahmad Hayek
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  2. Léa Azar
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  3. Matteo Pozzi
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Correspondence to Ahmad Hayek.

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Supplementary Information

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Supplementary figure 1.

Kaplan-Meier survival curve for all patients (n=265). Comparison of survival between the time spans (1981-1990 vs. 1991-2000 vs. 2001-2010 vs. 2011-2020 [A] and 1981-1990 vs. 1991-2020 [B]) (TIF 1509 KB)

Supplementary figure 2.

A historical timeline describing the 5-year number of VSD and in-hospital mortality evolution over 40 years. Key historical events were also implemented. (TIF 3868 KB)

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Hayek, A., Azar, L., Pozzi, M. et al. Ventricular septal rupture: insights into an old disease. Heart Vessels 37, 1305–1315 (2022). https://doi.org/10.1007/s00380-022-02031-0

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