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Early and late mortality and morbidity after post-MI ventricular septal rupture repair: predictors, strategies, and results

  • Kartik Patel
  • Amber MalhotraEmail author
  • Komal Shah
  • Pranav Sharma
  • Chirag Doshi
  • Pankaj Garg
  • Vivek Wadhawa
  • Sumbul Siddiqui
  • Jigisha Pujara
Original Article
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Abstract

Purpose

There has been a shift in the paradigm of management of post-myocardial infarction ventricular septal rupture (MI VSR), with many authors reporting improved prognosis if the surgery can be “optimally delayed.” Timing of the procedure is of critical importance and our management (UPMS), and prognosis scores (UPPS) have proven to be relevant. However, long-term outcomes and their correlation with our scores had not been analyzed. In this study, we present our long-term results of post-MI-VSR repair and their correlation with our prognosis score (UPPS).

Methods

Seventy-one patients with post-MI VSR repair (2009–2017) were retrospectively studied. Patients were managed using standard institute protocols.

Results

The 30-day mortality was 56% (n = 40). During a mean follow-up of 4.91 ± 2.43 years, there were eight late deaths. Actuarial survival of 30-day survivors was 87% at 1 year, 74% at 5 years, and 69% at 10 years. Actuarial freedom from major adverse cardiovascular events (MACE) was 82% at 1 year, 72% at 2 years, and 72% at 8 years. The UPPS score predicts late mortality with sensitivity of 75% and negative predictive value of 84%.

Conclusion

Our prognostic score (UPPS) helps not only in predicting early mortality but also in identifying the patients who are likely to live longer. The management score (UPMS) also provides best timing for the procedure, which is helpful in optimal utilization of resources in the developing world. The accuracy of these scores is reasonable and may be helpful in the decision-making in this difficult subset.

Keywords

Myocardial infarction Ventricular septal rupture Extracorporeal membrane oxygenation 

Notes

Funding information

This work was supported by U.N. Mehta Institute of Cardiology and Research Center itself and received no specific grant from any funding agency, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

This study does not involve the use of any animal. Also, in the case of patients, all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent has been taken from patients, and none has been forced to be a part of study.

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Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2019

Authors and Affiliations

  • Kartik Patel
    • 1
  • Amber Malhotra
    • 1
    Email author
  • Komal Shah
    • 2
  • Pranav Sharma
    • 1
  • Chirag Doshi
    • 1
  • Pankaj Garg
    • 1
  • Vivek Wadhawa
    • 1
  • Sumbul Siddiqui
    • 1
  • Jigisha Pujara
    • 3
  1. 1.Department of Cardio Vascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research CenterBJ Medical CollegeAhmedabadIndia
  2. 2.Department of Research, U.N. Mehta Institute of Cardiology and Research CenterBJ Medical CollegeAhmedabadIndia
  3. 3.Department of Cardiac Anaesthesia, U. N. Mehta Institute of Cardiology and Research CenterBJ Medical CollegeAhmedabadIndia

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