Surgical repair of post-infarction ventricular septal defect resulted in lower in-hospital mortality than percutaneous repair, with no difference in post-discharge long-term mortality.
Does percutaneous repair reduce mortality compared to surgical repair in patients with post-infarction ventricular septal defect?
While in-hospital mortality is lower with surgical repair, long-term post-discharge mortality is similar between percutaneous and surgical management of post-infarction ventricular septal defect.
Absolute Event Rate: 0% vs 0%
AIMS: Post-infarction ventricular septal defect (PIVSD) is a mechanical complication of acute myocardial infarction (AMI) with a poor prognosis. Surgical repair is the mainstay of treatment, although percutaneous closure is increasingly undertaken. METHODS AND RESUTS: Patients treated with surgical or percutaneous repair of PIVSD (2010-2021) were identified at 16 UK centres. Case note review was undertaken. The primary outcome was long-term mortality. Patient groups were allocated based upon initial management (percutaneous or surgical). Three-hundred sixty-two patients received 416 procedures (131 percutaneous, 231 surgery). 16.1% of percutaneous patients subsequently had surgery. 7.8% of surgical patients subsequently had percutaneous treatment. Times from AMI to treatment were similar percutaneous 9 (6-14) vs. surgical 9 (4-22) days, P = 0.18. Surgical patients were more likely to have cardiogenic shock (62.8% vs. 51.9%, P = 0.044). Percutaneous patients were substantially older 72 (64-77) vs. 67 (61-73) years, P < 0.001 and more likely to be discussed in a heart team setting. There was no difference in long-term mortality between patients (61.1% vs. 53.7%, P = 0.17). In-hospital mortality was lower in the surgical group (55.0% vs. 44.2%, P = 0.048) with no difference in mortality after hospital discharge (P = 0.65). Cardiogenic shock adjusted hazard ratio (aHR) 1.97 (95% confidence interval 1.37-2.84), P < 0.001), percutaneous approach [aHR 1.44 (1.01-2.05), P = 0.042, and number of vessels with coronary artery disease aHR 1.22 (1.01-1.47), P = 0.043 were independently associated with long-term mortality. CONCLUSION: Surgical and percutaneous repair are viable options for management of PIVSD. There was no difference in post-discharge long-term mortality between patients, although in-hospital mortality was lower for surgery.
“Both percutaneous and surgical management are complementary in real-world clinical practice and offer significant survival advantage compared to historical data on medical therapy. Shared decision-making through the heart team is key for patients.”
Giblett et al. (Sat,) reported a other. Surgical repair of post-infarction ventricular septal defect resulted in lower in-hospital mortality than percutaneous repair, with no difference in post-discharge long-term mortality.
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