Techniques, Timing & Prognosis of Post Infarct Ventricular Septal Repair: a Re-look at Old Dogmas
Abstract Objective: The study aimed to identify the factors affecting the prognosis of post myocardial infarction (MI) ventricular septal rupture (VSR) and to develop a protocol for its management. Methods: This was a single center, retrospective-prospective study (2009-2014), involving 55 patient...
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| Format: | Article |
| Language: | English |
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Sociedade Brasileira de Cirurgia Cardiovascular
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| Series: | Brazilian Journal of Cardiovascular Surgery |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382017000300147&lng=en&tlng=en |
| _version_ | 1818231873199931392 |
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| author | Amber Malhotra Kartik Patel Pranav Sharma Vivek Wadhawa Tarun Madan Jagdish Khandeparkar Komal Shah Sanjay Patel |
| author_facet | Amber Malhotra Kartik Patel Pranav Sharma Vivek Wadhawa Tarun Madan Jagdish Khandeparkar Komal Shah Sanjay Patel |
| author_sort | Amber Malhotra |
| collection | DOAJ |
| description | Abstract Objective: The study aimed to identify the factors affecting the prognosis of post myocardial infarction (MI) ventricular septal rupture (VSR) and to develop a protocol for its management. Methods: This was a single center, retrospective-prospective study (2009-2014), involving 55 patients with post MI VSR. The strengths of association between risk factors and prognosis were assessed using multivariate logistic regression analysis. The UNM Post MI VSR management and prognosis scoring systems (UPMS & UPPS) were developed. Results: Thirty-day mortality was 52.5% (35% in the last 3 years). Twenty-eight (70%) patients underwent concomitant coronary artery bypass grafting. Residual ventricular septal defect was found in 3 (7.5%) patients. The multivariate analysis showed low mean blood pressure with intra-aortic balloon pump (OR 11.43, P=0.001), higher EuroSCORE II (OR 7.47, P=0.006), higher Killip class (OR 27.95, P=0.00), and shorter intervals between MI and VSR (OR 7.90, P=0.005) as well as VSR and Surgery (OR 5.76, P=0.016) to be strong predictors of mortality. Concomitant coronary artery bypass grafting (P=0.17) and location (P=0.25) of VSR did not affect the outcome. Mean follow-up was 635.8±472.5 days and 17 out of 19 discharged patients were in NYHA class I-II. Conclusion: The UNM Post-MI VSR Scoring Systems (UPMS & UPPS) help in management and prognosis, respectively. They divide patients into 3 groups: 1) Immediate Surgery - Patients with scores of <25 require immediate surgery, preferably with extracorporeal membrane oxygenation support, and have poor prognosis; 2) Those with scores of 25-75 should be managed with "Optimal Delay" and they have intermediate outcomes; 3) Patients with scores of >75 can undergo Elective Repair and they are likely to have good outcomes. |
| first_indexed | 2024-12-12T10:57:18Z |
| format | Article |
| id | doaj.art-9a0ecc9b0af643acb4df3bbec41dc05f |
| institution | Directory Open Access Journal |
| issn | 1678-9741 |
| language | English |
| last_indexed | 2024-12-12T10:57:18Z |
| publisher | Sociedade Brasileira de Cirurgia Cardiovascular |
| record_format | Article |
| series | Brazilian Journal of Cardiovascular Surgery |
| spelling | doaj.art-9a0ecc9b0af643acb4df3bbec41dc05f2022-12-22T00:26:38ZengSociedade Brasileira de Cirurgia CardiovascularBrazilian Journal of Cardiovascular Surgery1678-974132314715510.21470/1678-9741-2016-0032S0102-76382017000300147Techniques, Timing & Prognosis of Post Infarct Ventricular Septal Repair: a Re-look at Old DogmasAmber MalhotraKartik PatelPranav SharmaVivek WadhawaTarun MadanJagdish KhandeparkarKomal ShahSanjay PatelAbstract Objective: The study aimed to identify the factors affecting the prognosis of post myocardial infarction (MI) ventricular septal rupture (VSR) and to develop a protocol for its management. Methods: This was a single center, retrospective-prospective study (2009-2014), involving 55 patients with post MI VSR. The strengths of association between risk factors and prognosis were assessed using multivariate logistic regression analysis. The UNM Post MI VSR management and prognosis scoring systems (UPMS & UPPS) were developed. Results: Thirty-day mortality was 52.5% (35% in the last 3 years). Twenty-eight (70%) patients underwent concomitant coronary artery bypass grafting. Residual ventricular septal defect was found in 3 (7.5%) patients. The multivariate analysis showed low mean blood pressure with intra-aortic balloon pump (OR 11.43, P=0.001), higher EuroSCORE II (OR 7.47, P=0.006), higher Killip class (OR 27.95, P=0.00), and shorter intervals between MI and VSR (OR 7.90, P=0.005) as well as VSR and Surgery (OR 5.76, P=0.016) to be strong predictors of mortality. Concomitant coronary artery bypass grafting (P=0.17) and location (P=0.25) of VSR did not affect the outcome. Mean follow-up was 635.8±472.5 days and 17 out of 19 discharged patients were in NYHA class I-II. Conclusion: The UNM Post-MI VSR Scoring Systems (UPMS & UPPS) help in management and prognosis, respectively. They divide patients into 3 groups: 1) Immediate Surgery - Patients with scores of <25 require immediate surgery, preferably with extracorporeal membrane oxygenation support, and have poor prognosis; 2) Those with scores of 25-75 should be managed with "Optimal Delay" and they have intermediate outcomes; 3) Patients with scores of >75 can undergo Elective Repair and they are likely to have good outcomes.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382017000300147&lng=en&tlng=enMyocardial InfarctionHeart Septal Defects, VentricularCardiac Surgical ProceduresPrognosis |
| spellingShingle | Amber Malhotra Kartik Patel Pranav Sharma Vivek Wadhawa Tarun Madan Jagdish Khandeparkar Komal Shah Sanjay Patel Techniques, Timing & Prognosis of Post Infarct Ventricular Septal Repair: a Re-look at Old Dogmas Brazilian Journal of Cardiovascular Surgery Myocardial Infarction Heart Septal Defects, Ventricular Cardiac Surgical Procedures Prognosis |
| title | Techniques, Timing & Prognosis of Post Infarct Ventricular Septal Repair: a Re-look at Old Dogmas |
| title_full | Techniques, Timing & Prognosis of Post Infarct Ventricular Septal Repair: a Re-look at Old Dogmas |
| title_fullStr | Techniques, Timing & Prognosis of Post Infarct Ventricular Septal Repair: a Re-look at Old Dogmas |
| title_full_unstemmed | Techniques, Timing & Prognosis of Post Infarct Ventricular Septal Repair: a Re-look at Old Dogmas |
| title_short | Techniques, Timing & Prognosis of Post Infarct Ventricular Septal Repair: a Re-look at Old Dogmas |
| title_sort | techniques timing prognosis of post infarct ventricular septal repair a re look at old dogmas |
| topic | Myocardial Infarction Heart Septal Defects, Ventricular Cardiac Surgical Procedures Prognosis |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382017000300147&lng=en&tlng=en |
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