Key result
Primary transcatheter post-MI VSD closure achieves high procedural success but only 35% 30-day survival.
Why the study?
Does primary transcatheter VSD closure provide a safe and effective alternative to surgery for patients with acute postinfarction ventricular septal defect?
Observational (n=29)
Does primary transcatheter VSD closure provide a safe and effective alternative to surgery for patients with acute postinfarction ventricular septal defect?
Primary transcatheter closure of postinfarction VSD is technically feasible with high procedural success, but 30-day mortality remains high, particularly in patients presenting with cardiogenic shock.
Answers are grounded in this paper and cite their sources.
Interventional VSD closure offers less-invasive alternative with high success; leaves open high residual mortality in cardiogenic shock pending device advances.
AIMS: Immediate surgical repair of ventricular septal defect (VSD) complicating acute myocardial infarction is associated with high mortality. Percutaneous device closure appears to be safe and effective in patients treated for a residual shunt after initial surgical closure, as well as in patients with a chronic post-infarct VSD. Primary transcatheter VSD closure in the acute setting may also offer advantages over surgery. METHODS AND RESULTS: Between September 2003 and February 2008, 29 consecutive patients underwent primary transcatheter VSD closure. Clinical, procedural, and outcome data were collected. Patients were divided into those with and those without cardiogenic shock at presentation for risk stratification. The median follow-up time of surviving patients was 730 days. The median time between VSD occurrence and closure was 1 day [interquartile range (IQR) 1-3] and the initial procedural success rate was 86%. The shunt (Qp:Qs) could be reduced from 3.3 (IQR 2.3-3.8) to 1.4 (IQR 1.2-1.7; P < 0.001). Procedure-related complications such as major residual shunting, left ventricular rupture, and device embolization occurred in 41%. The overall 30-day survival rate was 35%. Mortality was higher for cardiogenic shock in comparison to non-shock patients (88 vs. 38%, P < 0.001). CONCLUSION: Interventional acute VSD closure is a promising technique that can be performed with a high procedural success rate and may offer an alternative to surgery. Despite the less invasive technique, mortality of postinfarction VSD remains high, particularly in patients with cardiogenic shock. Further developments in devices and delivery techniques are required.
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Thiele et al. (2008) conducted an observational in Postinfarction ventricular septal defect (VSD) (n=29). Primary transcatheter VSD closure was evaluated on Overall 30-day survival rate. Primary transcatheter VSD closure achieved an 86% procedural success rate and 35% 30-day survival, with higher mortality in cardiogenic shock patients (88% vs 38%, P<0.001).
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