Benefits and Risks of Delayed Surgery for Ventricular Septal Rupture after Acute Myocardial Infarction

• Published in: International Heart Journal Vol. 63; no. 3; pp. 433 - 440
• Main Authors: Furui, Masato, Sakurai, Yoshihiko, Kakii, Bunpachi, Asanuma, Mai, Nishioka, Hiroaki, Yoshida, Takeshi
• Format: Journal Article
• Language: English
• Published: Japan International Heart Journal Association 30-05-2022; Japan Science and Technology Agency
• Subjects: Blood flow; Catheters; Echocardiographic findings; Heart attacks; Humans; Intravenous administration; Mortality; Myocardial infarction; Myocardial Infarction - complications; Myocardial Infarction - surgery; Patients; Preoperative management; Qp/Qs change; Retrospective Studies; Risk Assessment; Risk Factors; Rupture; Surgery; Timing of surgery; Ventricle; Ventricular Septal Rupture - etiology; Ventricular Septal Rupture - surgery; Withholding surgery; Qp/Qs change; Echocardiographic findings; Withholding surgery; Preoperative management; Timing of surgery
• ISSN: 1349-2365; 1349-3299
• DOI: 10.1536/ihj.21-581

The timing of surgery for ventricular septal rupture (VSR) after acute myocardial infarction (AMI) remains controversial. This study investigated the benefits and risks of delayed surgery for post-AMI VSR and examined differences in echocardiographic findings between early and delay groups.A total of 38 consecutive patients with post-AMI VSR who underwent surgery at our hospital between May 2003 and November 2020 were retrospectively analyzed. Our strategy was to delay surgery until 2 weeks after AMI. If patients demonstrated organ dysfunction, we considered early surgery. Patients were divided into early (n = 20; 53%) and delay (n = 18; 47%) groups. Risks and benefits were investigated based on echocardiographic findings during the waiting period. The delay group had more preoperative intravenous catheter infections (P = 0.008) but fewer reoperations (P = 0.02) and lower operative mortality (P = 0.04) than the early group. The VSR defect diameter and total pulmonary blood flow to total systemic blood flow (Qp/Qs) increased in both groups while waiting. Nevertheless, the early group had a significantly higher Qp/Qs change rate than the delay group (P = 0.05). The 30 day and hospital mortality rates were 5.3% and 13.2%, respectively.The VSR defect diameter and Qp/Qs in both groups increased with time and can therefore become risk factors. Nonetheless, the benefit of waiting exceeded the risk because our outcomes were better than those previously reported.