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. 2022 Dec 21;43(48):5020-5032.
doi: 10.1093/eurheartj/ehac511.

Post-infarction ventricular septal defect: percutaneous or surgical management in the UK national registry

Joel P Giblett  1   2 , Andrija Matetic  3   4 , David Jenkins  5 , Choo Y Ng  5 , Shreenidhi Venuraju  2 , Tobias MacCarthy  2   6 , Jonathan Vibhishanan  2   6 , John P O'Neill  7 , Bilal H Kirmani  1   8 , D Mark Pullan  8 , Rod H Stables  1 , Jack Andrews  9 , Nicolas Buttinger  10 , Wan Cheol Kim  11 , Ritesh Kanyal  12 , Megan A Butler  13 , Robert Butler  14 , Sudhakar George  15 , Ayush Khurana  16 , David S Crossland  17 , Jakub Marczak  18 , William H T Smith  18 , John D R Thomson  19 , James R Bentham  19 , Brian R Clapp  20 , Mamta Buch  21 , Nicholas Hayes  22 , Jonathan Byrne  12 , Philip MacCarthy  12 , Suneil K Aggarwal  1 , Leonard M Shapiro  2 , Mark S Turner  11 , Joe de Giovanni  15 , David B Northridge  9 , David Hildick-Smith  10 , Mamas A Mamas  3   13 , Patrick A Calvert  2   6
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Post-infarction ventricular septal defect: percutaneous or surgical management in the UK national registry

Joel P Giblett et al. Eur Heart J. .

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.

Keywords: Percutaneous ventricular septal defect repair; Post-infarction ventricular septal defect; Ventricular septal rupture.

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Conflict of interest statement

Conflict of interest: B.R.C. has received speaking fees from Abbott Vascular. P.M. has provided expert testimony and worked as a speaker for Edwards Lifesciences. J.B. has worked as a proctor for Abbott Vascular. M.S.T. has worked as a consultant and received educational grants from Occlutech. He has worked as a consultant and proctor for Abbott Vascular. D.B.N. has worked as a proctor for Abbott Vascular. D.H.-S. has received travel support and worked as a proctor for Abbott Vascular and Boston Scientific; he has received consulting fees and participated in a data and safety monitoring board for Abbott Vascular. M.A.M. has received non-restrictive educational grants from Abbott Vascular and Terumo, and worked as a consultant for Daiichi Sankyo and Terumo. P.A.C. has worked as a proctor for Abbott Vascular, Gore Medical and Occlutech.

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