Incidence, management, and prognosis of post-ischaemic ventricular septal defect: Insights from a 12-year tertiary centre experience
BackgroundAmong mechanical complications of acute myocardial infarction, ventricular septal defect (VSD) is uncommon but still serious. The evolution of emergency coronary revascularisation paradoxically decreased our knowledge of this disease, making it even rarer.AimTo describe ischaemic VSD incid...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-12-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.1066308/full |
| _version_ | 1811209265293033472 |
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| author | Henri Treille de Grandsaigne Henri Treille de Grandsaigne Frédéric Bouisset Jean Porterie Caroline Biendel Caroline Biendel Bertrand Marcheix Olivier Lairez François Labaste Meyer Elbaz Michel Galinier Michel Galinier Clément Delmas Clément Delmas |
| author_facet | Henri Treille de Grandsaigne Henri Treille de Grandsaigne Frédéric Bouisset Jean Porterie Caroline Biendel Caroline Biendel Bertrand Marcheix Olivier Lairez François Labaste Meyer Elbaz Michel Galinier Michel Galinier Clément Delmas Clément Delmas |
| author_sort | Henri Treille de Grandsaigne |
| collection | DOAJ |
| description | BackgroundAmong mechanical complications of acute myocardial infarction, ventricular septal defect (VSD) is uncommon but still serious. The evolution of emergency coronary revascularisation paradoxically decreased our knowledge of this disease, making it even rarer.AimTo describe ischaemic VSD incidence, management, and associated in-hospital and 1-year outcomes over a 12-years period.MethodsA retrospective single-centre register of patients managed for ischaemic VSD between January 2009 and December 2020.ResultsNinety-seven patients were included representing 8 patients/ years and an incidence of 0.44% of ACS managed. The majority of the patients were 73-years-old males (n = 54, 56%) with STEMI presentation (n = 75, 79%) and already presented with Q necrosis on ECG (n = 70, 74%). Forty-nine (51%) patients underwent PCI, 60 (62%) inotrope/vasopressors infusion, and 70 (72%) acute mechanical circulatory support (IABP 62%, ECMO 13%, and Impella® 3%). VSD surgical repair was performed for 44 patients (45%) and 1 patient was transplanted. In-hospital mortality was 71%, and 86% at 1 year, without significant improvement over the decade. Surgery appears to be a protective factor [0.51 (0.28–0.94) p = 0.003], whereas age [1.06 (1.03–1.09), p < 0.001] and lactate [1.16 (1.09–1.23), p < 0.001] were linked to higher 1-year mortality. None of the patients that were managed medically survived 1 year.ConclusionPost-ischaemic VSD is a rare but serious complication still associated with high mortality. Corrective surgery is associated with better survival, however, timing, patient selection, and a place for mechanical circulatory support need to be defined. |
| first_indexed | 2024-04-12T04:35:24Z |
| format | Article |
| id | doaj.art-1b154da314dc4daa826cb2409ca8f5c0 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-12T04:35:24Z |
| publishDate | 2022-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-1b154da314dc4daa826cb2409ca8f5c02022-12-22T03:47:48ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-12-01910.3389/fcvm.2022.10663081066308Incidence, management, and prognosis of post-ischaemic ventricular septal defect: Insights from a 12-year tertiary centre experienceHenri Treille de Grandsaigne0Henri Treille de Grandsaigne1Frédéric Bouisset2Jean Porterie3Caroline Biendel4Caroline Biendel5Bertrand Marcheix6Olivier Lairez7François Labaste8Meyer Elbaz9Michel Galinier10Michel Galinier11Clément Delmas12Clément Delmas13Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, FranceCardiology Department, Rangueil University Hospital, Toulouse, FranceCardiology Department, Rangueil University Hospital, Toulouse, FranceCardiovascular Surgery Department, Rangueil University Hospital, Toulouse, FranceIntensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, FranceCardiology Department, Rangueil University Hospital, Toulouse, FranceCardiovascular Surgery Department, Rangueil University Hospital, Toulouse, FranceCardiology Department, Rangueil University Hospital, Toulouse, FranceDepartment of Anesthesiology, Intensive Care Medicine and Perioperative Medicine, Rangueil University Hospital, Toulouse, FranceCardiology Department, Rangueil University Hospital, Toulouse, FranceIntensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, FranceCardiology Department, Rangueil University Hospital, Toulouse, FranceIntensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, FranceCardiology Department, Rangueil University Hospital, Toulouse, FranceBackgroundAmong mechanical complications of acute myocardial infarction, ventricular septal defect (VSD) is uncommon but still serious. The evolution of emergency coronary revascularisation paradoxically decreased our knowledge of this disease, making it even rarer.AimTo describe ischaemic VSD incidence, management, and associated in-hospital and 1-year outcomes over a 12-years period.MethodsA retrospective single-centre register of patients managed for ischaemic VSD between January 2009 and December 2020.ResultsNinety-seven patients were included representing 8 patients/ years and an incidence of 0.44% of ACS managed. The majority of the patients were 73-years-old males (n = 54, 56%) with STEMI presentation (n = 75, 79%) and already presented with Q necrosis on ECG (n = 70, 74%). Forty-nine (51%) patients underwent PCI, 60 (62%) inotrope/vasopressors infusion, and 70 (72%) acute mechanical circulatory support (IABP 62%, ECMO 13%, and Impella® 3%). VSD surgical repair was performed for 44 patients (45%) and 1 patient was transplanted. In-hospital mortality was 71%, and 86% at 1 year, without significant improvement over the decade. Surgery appears to be a protective factor [0.51 (0.28–0.94) p = 0.003], whereas age [1.06 (1.03–1.09), p < 0.001] and lactate [1.16 (1.09–1.23), p < 0.001] were linked to higher 1-year mortality. None of the patients that were managed medically survived 1 year.ConclusionPost-ischaemic VSD is a rare but serious complication still associated with high mortality. Corrective surgery is associated with better survival, however, timing, patient selection, and a place for mechanical circulatory support need to be defined.https://www.frontiersin.org/articles/10.3389/fcvm.2022.1066308/fullacute cardiac careacute coronary syndromemortalitycomplicationepidemiology |
| spellingShingle | Henri Treille de Grandsaigne Henri Treille de Grandsaigne Frédéric Bouisset Jean Porterie Caroline Biendel Caroline Biendel Bertrand Marcheix Olivier Lairez François Labaste Meyer Elbaz Michel Galinier Michel Galinier Clément Delmas Clément Delmas Incidence, management, and prognosis of post-ischaemic ventricular septal defect: Insights from a 12-year tertiary centre experience Frontiers in Cardiovascular Medicine acute cardiac care acute coronary syndrome mortality complication epidemiology |
| title | Incidence, management, and prognosis of post-ischaemic ventricular septal defect: Insights from a 12-year tertiary centre experience |
| title_full | Incidence, management, and prognosis of post-ischaemic ventricular septal defect: Insights from a 12-year tertiary centre experience |
| title_fullStr | Incidence, management, and prognosis of post-ischaemic ventricular septal defect: Insights from a 12-year tertiary centre experience |
| title_full_unstemmed | Incidence, management, and prognosis of post-ischaemic ventricular septal defect: Insights from a 12-year tertiary centre experience |
| title_short | Incidence, management, and prognosis of post-ischaemic ventricular septal defect: Insights from a 12-year tertiary centre experience |
| title_sort | incidence management and prognosis of post ischaemic ventricular septal defect insights from a 12 year tertiary centre experience |
| topic | acute cardiac care acute coronary syndrome mortality complication epidemiology |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.1066308/full |
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