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. 2022 Dec 6:9:1066308.
doi: 10.3389/fcvm.2022.1066308. eCollection 2022.

Incidence, management, and prognosis of post-ischaemic ventricular septal defect: Insights from a 12-year tertiary centre experience

Henri Treille de Grandsaigne  1   2 , Frédéric Bouisset  2 , Jean Porterie  3 , Caroline Biendel  1   2 , Bertrand Marcheix  3 , Olivier Lairez  2 , François Labaste  4 , Meyer Elbaz  2 , Michel Galinier  1   2 , Clément Delmas  1   2
Affiliations

Incidence, management, and prognosis of post-ischaemic ventricular septal defect: Insights from a 12-year tertiary centre experience

Henri Treille de Grandsaigne et al. Front Cardiovasc Med. .

Abstract

Background: Among mechanical complications of acute myocardial infarction, ventricular septal defect (VSD) is uncommon but still serious. The evolution of emergency coronary revascularisation paradoxically decreased our knowledge of this disease, making it even rarer.

Aim: To describe ischaemic VSD incidence, management, and associated in-hospital and 1-year outcomes over a 12-years period.

Methods: A retrospective single-centre register of patients managed for ischaemic VSD between January 2009 and December 2020.

Results: Ninety-seven patients were included representing 8 patients/ years and an incidence of 0.44% of ACS managed. The majority of the patients were 73-years-old males (n = 54, 56%) with STEMI presentation (n = 75, 79%) and already presented with Q necrosis on ECG (n = 70, 74%). Forty-nine (51%) patients underwent PCI, 60 (62%) inotrope/vasopressors infusion, and 70 (72%) acute mechanical circulatory support (IABP 62%, ECMO 13%, and Impella® 3%). VSD surgical repair was performed for 44 patients (45%) and 1 patient was transplanted. In-hospital mortality was 71%, and 86% at 1 year, without significant improvement over the decade. Surgery appears to be a protective factor [0.51 (0.28-0.94) p = 0.003], whereas age [1.06 (1.03-1.09), p < 0.001] and lactate [1.16 (1.09-1.23), p < 0.001] were linked to higher 1-year mortality. None of the patients that were managed medically survived 1 year.

Conclusion: Post-ischaemic VSD is a rare but serious complication still associated with high mortality. Corrective surgery is associated with better survival, however, timing, patient selection, and a place for mechanical circulatory support need to be defined.

Keywords: acute cardiac care; acute coronary syndrome; complication; epidemiology; mortality.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Annual numerical comparison of acute coronary syndromes (Non-STEMI and STEMI) and ischemic VSD managed between June 2012 and December 2020. Number of Non-STEMI (red) and STEMI (blue) per year are reported on the left axis although VSD (green) is reported on the right. Patients before January 2012 were nor reported since an old data system did not permit a systematic counting of all consecutive cases. ACS, acute coronary syndrome; NSTEMI, non-ST-elevated myocardial infarction; STEMI, ST-elevated myocardial infarction; VSD, ventricular septal defect.
Figure 2
Figure 2
Ischemic ventricular septal defect survival according to the realization of surgical repair (red curve) or not with only medical management (blue curve). Log-rank test p-value < 0.001. On 97 patients. 11 patients were lost of follow-up and not included in survival analysis.
Figure 3
Figure 3
Annual VSD count between 2009 and 2020 and associated 1-year mortality. Left axis reports number of ischemic VSD per year. Right axis reports the ischemic VSD 1-year associated mortality. VSD, ventricular septal defect.
See this image and copyright information in PMC

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