Outcomes of post myocardial infarction ventricular septal rupture: Experience from an Indian tertiary cardiac center

BACKGROUND: Post myocardial infarction ventricular septal rupture (MI-VSR) is a devastating complication after acute myocardial infarction (AMI); lacks uniform treatment recommendations and carries poor outcomes. OBJECTIVES: To evaluate the outcomes of post MI-VSR, stratify based on management strategy and determine the predictors of survival. METHODS: All cases of VSR hospitalized in a tertiary referral cardiac care center over 11 years were retrospectively evaluated for various parameters and stratified based on the modality of treatment, either conservative, surgical or transcatheter closure. RESULTS: Among a total of 131 cases of VSR with a median age of 65 years, hospitalized from January 2013 to December 2023, 47(35.9 %) had surgical closure, 25(19.1 %) had transcatheter closure and the rest were managed conservatively. 11(8.4 %) cases alone underwent primary percutaneous coronary intervention (PCI). Apex was the commonest (79.3 %) site. Older patients and patients in higher stages of shock at the time of VSR diagnosis were often managed conservatively. Two-thirds of surgical patients were in SHOCK stage A or B; three-fourths of transcatheter group were in stage C or D. Overall mortality was 71 % with 100 % in conservative, 68 % in transcatheter closure and 36.2 % in surgical group. Younger age, lower shock stage, VSR closure, and delayed closure were predictors of survival. CONCLUSIONS: Post MI VSR outcomes were poor, based on the hemodynamic status. Closure of VSR is essential for survival. Surgical closure had lower mortality than transcatheter closure possibly contributed by a selection bias.