CT09ACUTE ISCHAEMIC VENTRICULAR SEPTAL RUPTURE - A FORMIDABLE SURGICAL CHALLENGE

To evaluate our surgical results for ischaemic Ventricular Septal Rupture and suggest practice guidelines. A retrospective review of data from patient records from 1992 to 2006 for presentation, surgical approaches, recurrence and mortality and analyzed for future management guidelines. We had 36 patients with a mean age of 70.44(+/- 6.34). 14 patients (38.9%) had an inferior/ posterior defect, 28 were in shock (22 on IABP). Severe LV and RV dysfunction were present in 18 and 20 patients respectively. Repair involved patches after infarctectomy (17) or infarct exclusion (18), using either continuous or interrupted suture. Concomitant CABG was performed in 15. 11 patients had residual shunts, 2 requiring device closure and one surgery. Prolonged ICU and hospital stay was the norm. Early mortality was 52.78% (inferior defects - 85.71%, anterior defects - 31.82%). On Univariate analysis Inferior VSD (OR 7.7; 95% CI 1.7, 33.3), Moderate to severe RV impairment (OR 5.0; 95% CI 0.92, 33.3), Pre op shock (OR 6.7; 95% CI 1.6, 33.3), Early presentation post MI and infarctectomy during repair (3.8; 95% CI 0.9, 15.4), predicted mortality. For subgroup of anterior VSD, only pre-op shock (OR11.1; 95% CI 1.0, 100) predicted a poor outcome. On multivariate analysis, Inferior defects and shock at presentation were the dominant predictors for early death. Repair without cardioplegia (OR5.2; 95% CI 0.48, 56.09) was the only risk factor for recurrence. Acute ischaemic VSD is a grim surgical disease with high mortality. Inferior defects should be offered surgery only in exceptional circumstances due to uniformly poor outcome. [PUBLICATION ABSTRACT]