Post-infarction ventricular septal defect: percutaneous or surgical management in the UK national registry
Joel P. Giblett, Andrija Matetić, David P. Jenkins, Choo Ng, Shreenidhi Venuraju, Tobias MacCarthy, Jonathan Vibhishanan, John P O’Neill, Bilal H. Kirmani, D. Mark Pullan, Rod Stables, Jack Andrews, Nicolas Buttinger, Wan Kim, Ritesh Kanyal, Megan Butler, Robert J. Butler, Sudhakar George, Ayush Khurana, David Crossland, Jakub Marczak, William Smith, John Thomson, James R. Bentham, Brian Clapp, Mamta Buch, Nicholas Hayes, Jonathan Byrne, Philip MacCarthy, Suneil Aggarwal, Leonard M. Shapiro, Mark Turner, J De Giovanni, David B. Northridge, David Hildick‐Smith, Mamas A. Mamas, Patrick A. Calvert
Abstract
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.