A-54 | Mortality for Post-Infarct VSD Repair Patients was Predicted by Clinical Characteristics

Ventricular septal defect (VSD) is a life-threatening complication following delayed presentation of myocardial infarction (MI). This study assesses clinical characteristics based on mortality following surgical repair of post MI-VSD. The study included all patients who had post MI-VSD from a regional quality collaborative between 05/2008 and 01/2020. Of a total of 79 patients who received surgical repair, 31 (39%) were aged ≥ 70 years, 49 (62%) were male, 61 (77%) were white, and 28 (35%) died. Cardiogenic shock (CS) was observed in 56% (survival vs. mortality: 39% vs. 79%; p=0.001), while 6% of all patients required resuscitation (survival vs. mortality: 2% vs. 14%; p=0.05). Emergent surgery was performed in 30% (survival vs. mortality: 14% vs. 61%; p<0.001) and aortic valve surgery in 10% (survival vs. mortality: 11% vs. 9%; p=0.029). Intraoperatively, extracorporeal membrane oxygenation (ECMO) was used in 22% (survival vs. mortality: 4% vs. 68%; p<0.001) and blood products in 49% (survival vs. mortality: 45% vs. 57%; p=0.005). Following repair, 22% suffered from renal failure (survival vs. mortality: 19% vs. 48%; p=0.021), 10% had a cardiac arrest (survival vs. mortality: 3% vs. 30%; p=0.007), and 20% experienced atrial fibrillation (AF) (survival vs. mortality: 44% vs. 9%; p=0.005). Patients who experienced in-hospital mortality following MI-VSD had worse baseline comorbidity burden and were more likely to receive mechanical circulatory support devices. Improvement in patient selection and new therapeutic options are needed as part of advanced care for mechanical complications of MI.