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Surgical repair of post infarction ventricular septa defects: a national experience

Jeppsson, A; Liden, H; Johnsson, Pelle LU ; Hartford, M and Radegran, K (2005) In European Journal of Cardio-thoracic Surgery 27(2). p.216-221
Abstract
Obiectives: Ventricular septal rupture is a rare but feared complication after acute myocardial infarction. Most reports about outcome after surgical treatment are single center experiences. We investigated the results after surgical repair in all patients in Sweden during a 7-year period. Methods: All patients undergoing surgical repair 1992-1998 were identified with the aid of the Swedish Heart Surgery Registry. The patients (n = 189, 63% men, mean age 69 8 years) were operated at 10 different centers. Pre- and peri-operative variables were collected from the Registry and individual patient charts. Mortality was calculated and a Cox proportional hazards regression model was used to identify independent predictors for early and late... (More)
Obiectives: Ventricular septal rupture is a rare but feared complication after acute myocardial infarction. Most reports about outcome after surgical treatment are single center experiences. We investigated the results after surgical repair in all patients in Sweden during a 7-year period. Methods: All patients undergoing surgical repair 1992-1998 were identified with the aid of the Swedish Heart Surgery Registry. The patients (n = 189, 63% men, mean age 69 8 years) were operated at 10 different centers. Pre- and peri-operative variables were collected from the Registry and individual patient charts. Mortality was calculated and a Cox proportional hazards regression model was used to identify independent predictors for early and late mortality. Mean follow-up was 2.4 years. Results: Seventy-seven of the 189 patients died within 30 days (41%). Urgent repair (Risk Ratio 4.2 (2.0-8.9), P < 0.001) and posterior rupture (RR 2.1 (1.3-3.4), P = 0.002) were independent predictors of 30-day mortality. Total cumulative survival (Kaplan-Meyer) was 38% at 5 years. For patients that survived the first 30 days (n = 112), 5 year cumulative survival was 67%. Independent predictors for mortality after 30 days were number of concomitant coronary anastomoses (RR 1.5 (1.2-2.0), P = 0.001), residual postoperative shunt (RR 2.7 (1.4-5.4), P = 0.004) and postoperative dialysis (RR 3.4 (1.5-7.5), P = 0.003). Conclusions: Early mortality after surgical repair of post infarction septal rupture is still considerable. Early repair and posterior rupture are predictors of early mortality. Long-term survival in patients surviving the immediate postoperative period is limited by pre-existing coronary artery disease, postoperative renal failure and the presence of a residual postoperative shunt. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
coronary artery bypass, grafting, post infarction ventncutar septat rupture, risk analysis, mortality
in
European Journal of Cardio-thoracic Surgery
volume
27
issue
2
pages
216 - 221
publisher
Elsevier
external identifiers
  • pmid:15691673
  • wos:000227328300007
  • scopus:13244269972
ISSN
1010-7940
DOI
10.1016/j.ejcts.2004.10.037
language
English
LU publication?
yes
id
99faa651-b1b9-4242-aed0-6570a6467ea0 (old id 250567)
alternative location
http://ejcts.ctsnetjournals.org/cgi/content/abstract/27/2/216
date added to LUP
2007-08-24 14:17:25
date last changed
2017-08-27 04:11:01
@article{99faa651-b1b9-4242-aed0-6570a6467ea0,
  abstract     = {Obiectives: Ventricular septal rupture is a rare but feared complication after acute myocardial infarction. Most reports about outcome after surgical treatment are single center experiences. We investigated the results after surgical repair in all patients in Sweden during a 7-year period. Methods: All patients undergoing surgical repair 1992-1998 were identified with the aid of the Swedish Heart Surgery Registry. The patients (n = 189, 63% men, mean age 69 8 years) were operated at 10 different centers. Pre- and peri-operative variables were collected from the Registry and individual patient charts. Mortality was calculated and a Cox proportional hazards regression model was used to identify independent predictors for early and late mortality. Mean follow-up was 2.4 years. Results: Seventy-seven of the 189 patients died within 30 days (41%). Urgent repair (Risk Ratio 4.2 (2.0-8.9), P &lt; 0.001) and posterior rupture (RR 2.1 (1.3-3.4), P = 0.002) were independent predictors of 30-day mortality. Total cumulative survival (Kaplan-Meyer) was 38% at 5 years. For patients that survived the first 30 days (n = 112), 5 year cumulative survival was 67%. Independent predictors for mortality after 30 days were number of concomitant coronary anastomoses (RR 1.5 (1.2-2.0), P = 0.001), residual postoperative shunt (RR 2.7 (1.4-5.4), P = 0.004) and postoperative dialysis (RR 3.4 (1.5-7.5), P = 0.003). Conclusions: Early mortality after surgical repair of post infarction septal rupture is still considerable. Early repair and posterior rupture are predictors of early mortality. Long-term survival in patients surviving the immediate postoperative period is limited by pre-existing coronary artery disease, postoperative renal failure and the presence of a residual postoperative shunt.},
  author       = {Jeppsson, A and Liden, H and Johnsson, Pelle and Hartford, M and Radegran, K},
  issn         = {1010-7940},
  keyword      = {coronary artery bypass,grafting,post infarction ventncutar septat rupture,risk analysis,mortality},
  language     = {eng},
  number       = {2},
  pages        = {216--221},
  publisher    = {Elsevier},
  series       = {European Journal of Cardio-thoracic Surgery},
  title        = {Surgical repair of post infarction ventricular septa defects: a national experience},
  url          = {http://dx.doi.org/10.1016/j.ejcts.2004.10.037},
  volume       = {27},
  year         = {2005},
}