Surgical Treatment of Ventricular Septal Rupture Based on Infarct-Related Vessel in Patients with Acute Myocardial Infarction: A Single-Center Comparative Outcome Study

Abstract

Background: The objective of this study was to review the patient characteristics and operative results in patients with postinfarction ventricular septal rupture (VSR) based on infarct-related vessel.

Methods: We used patient files and registry data to perform a review of 20 consecutive patients with VSR associated with acute myocardial infarction surgically treated at our hospital. The patients were divided into two groups according to the vessel in which the culprit lesion was located: the right coronary artery (RCA) group (n = 9) and left coronary artery (LCA) group (n = 11).

Results: The median ages of the patients in the RCA and LCA groups were 74.2 and 73.0 years, respectively. Although the interval between VSR onset and operation was not different between the two groups, operation within 24 hours occurred more frequently in the RCA group than LCA group (p = 0.043). The choice of operative techniques was not significantly different between the two groups. Operative mortality was significantly higher in the RCA group versus LCA group (5/9 [55%] vs 0/11 [0%], p = 0.005). Low output syndrome and sepsis occurred more frequently in the patients with operative mortality than in the survivors, whereas the rate of surgery within 24 hours of VSR onset was comparable between the two groups.

Conclusions: The poorer operative outcomes of the patients in the RCA group versus LCA group were considered to be due mainly to the more deteriorated condition of the RCA group patients.