Correlates of survival in patients with postinfarction ventricular septal defect.

Prognostic indicators of survival in 42 consecutive patients (21 men and 21 women) with postinfarction ventricular septal defect were reviewed. Infarct location was anterior in 57%, inferior in 33%, and combined in 10%. The hospital mortality among 9 patients not receiving surgical therapy was 100%. Of the 33 surgically treated patients, 19 (58%) survived. Time from diagnosis to operation, ventricular function, and presence or absence of shock were analyzed in a logistic regression model to determine which factors carried independent prognostic value. Shock was independently predictive of operative mortality (p less than 0.01). Of additional variables examined, nonsurvivors were characterized by a shorter time from postinfarction ventricular septal defect to operation, a relatively higher incidence of inferior infarction, moderate right ventricular dysfunction and mild left ventricular dysfunction, and a lower right ventricular systolic pressure. Results of postmortem examination were available for 15 nonsurvivors. Quantitative analysis of percent ventricle infarcted revealed that in patients with inferior infarctions, a mean of 31% of the right ventricle was infarcted compared with 10% in patients with anterior infarction (p = 0.059). Kaplan-Meier survival estimates revealed 1-year survival of 70%, 5-year survival of 55%, and 10-year survival of 20%. Seventy percent of survivors were in New York Heart Association class I or II. These data show that, irrespective of ventricular function or timing of operation, the development of shock is the most important predictor of survival in postinfarction ventricular septal defect. The higher mortality in patients with inferior infarction may be associated with a greater degree of right ventricular infarction and consequent dysfunction. Finally, long-term survival and excellent functional recovery can be achieved in patients undergoing operation.