Key result
Transcatheter closure of post-myocardial infarction ventricular septal rupture using ASD occluders resulted in a 30-day all-cause mortality rate of 42.9%.
Why the study?
Does primary transcatheter closure using ASD occluders provide reasonable survival outcomes in patients with post-myocardial infarction ventricular septal rupture?
Observational (n=21)
No
Does primary transcatheter closure using ASD occluders provide reasonable survival outcomes in patients with post-myocardial infarction ventricular septal rupture?
Primary transcatheter closure of post-MI VSR using ASD occluders is a feasible approach with a 30-day mortality rate of 42.9%, where higher MELD-XI scores, larger VSR diameter, and higher serum creatinine predict poorer outcomes.
Answers are grounded in this paper and cite their sources.
High mortality in this observational series cautions against routine use; leaves open whether transcatheter ASD occluder closure improves survival versus surgery.
The study investigated effectiveness of transcatheter closure of post-myocardial infarction (MI) ventricular septal rupture (VSR) using atrial septal device (ASD) occluder in a cohort of patients admitted at our institute. This was a retrospective, observational and single center study, which included patients who were treated with transcatheter closure for post-MI VSR at our tertiary care center between May 2000 and August 2014 depending upon inclusion and exclusion criteria. Primary outcome was all-cause mortality at 30-days follow-up. The MELD-XI (Model for End Stage Liver Disease) score was used as a predictor for poor outcome in these patients. A total of 21 patients (mean age 66.4 ± 5.9 years) were included in the study. Study cohort predominantly included male patients (n = 15; 71.4%) and patients with single vessel disease (n = 15; 71.4%). Revascularization of the culprit lesion, before VSR closure, was attempted in 6 patients. Except one patient (treated with Cera® occluder), all patients were treated with Amplatzer® ASD occluders. Average diameter of VSR was 20.8 ± 6.9 mm. Diameter of the device used in the study ranged from 10 mm to 30 mm. Residual defect was detected in 13 patients (62%). All-cause mortality at 30-day follow-up was observed in 9 (42.9%) patients. Time to VSR closure, diameter of VSR, and serum creatinine levels were significantly related to the 30-day mortality. MELD-XI score was found to be strongly associated with increased risk of mortality. Primary transcatheter VSR closure using ASD occluders is a feasible approach which can provide reasonable survival outcomes along with equitable mortality rates.
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Aggarwal et al. (2018) conducted an observational in post-myocardial infarction ventricular septal rupture (n=21). Transcatheter closure using atrial septal device (ASD) occluder was evaluated on all-cause mortality at 30-days follow-up. Transcatheter closure of post-myocardial infarction ventricular septal rupture using ASD occluders resulted in a 30-day all-cause mortality rate of 42.9%.
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