Matteo Matteucci1, Daniele Ronco2, Claudio Corazzari3, Dario Fina4, Federica Jiritano5, Paolo Meani4, Mariusz Kowalewski6, Cesare Beghi3, Roberto Lorusso4. 1. Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy. Electronic address: matteomatteucci87@gmail.com. 2. Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy. 3. Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy. 4. Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands. 5. Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Cardiac Surgery, University Magna Graecia of Catanzaro, Catanzaro, Italy. 6. Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands; Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland; Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcs, Poland.
Abstract
BACKGROUND: Ventricular septal rupture (VSR) is a rare but life-threatening complication after acute myocardial infarction. Although surgical correction is challenging and associated with high mortality, it remains the treatment of choice. This systematic review and meta-analysis aimed to evaluate the early outcome of surgical VSR repair. METHODS: We searched electronic databases from January 1998 to February 2020. Studies reporting patients undergoing surgical treatment for VSR were analyzed. The primary outcome assessed was operative mortality. Differences were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) to assess the relationships of predefined surgical variables and clinical prognosis. RESULTS: A total of 6361 adult patients from 41 studies were identified. Operative mortality was 38.2%. Pooled ORs showed increased odds of operative mortality in patients with preoperative or perioperative intraaortic balloon pump insertion (OR = 3.48; 95% CI, 3.01-4.02; P < .001), right ventricular dysfunction (OR = 2.85; 95% CI, 1.47-5.52; P = .002), posterior VSR (OR = 1.73; 95% CI, 1.30-2.31; P < .001), and emergency surgery (OR = 3.79; 95% CI, 2.52-5.72; P < .001). Temporal trend evaluation revealed no difference over time in the operative mortality rate; it was 34% in both time-related groups (1971-2000 versus 2001-2018). CONCLUSIONS: Ventricular septal rupture repair has a high operative mortality. Patients with preoperative or perioperative intraaortic balloon pump support, right ventricular dysfunction at presentation, or posterior defects, and those undergoing emergent VSR correction have increased odds of operative mortality.
BACKGROUND:Ventricular septal rupture (VSR) is a rare but life-threatening complication after acute myocardial infarction. Although surgical correction is challenging and associated with high mortality, it remains the treatment of choice. This systematic review and meta-analysis aimed to evaluate the early outcome of surgical VSR repair. METHODS: We searched electronic databases from January 1998 to February 2020. Studies reporting patients undergoing surgical treatment for VSR were analyzed. The primary outcome assessed was operative mortality. Differences were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) to assess the relationships of predefined surgical variables and clinical prognosis. RESULTS: A total of 6361 adult patients from 41 studies were identified. Operative mortality was 38.2%. Pooled ORs showed increased odds of operative mortality in patients with preoperative or perioperative intraaortic balloon pump insertion (OR = 3.48; 95% CI, 3.01-4.02; P < .001), right ventricular dysfunction (OR = 2.85; 95% CI, 1.47-5.52; P = .002), posterior VSR (OR = 1.73; 95% CI, 1.30-2.31; P < .001), and emergency surgery (OR = 3.79; 95% CI, 2.52-5.72; P < .001). Temporal trend evaluation revealed no difference over time in the operative mortality rate; it was 34% in both time-related groups (1971-2000 versus 2001-2018). CONCLUSIONS:Ventricular septal rupture repair has a high operative mortality. Patients with preoperative or perioperative intraaortic balloon pump support, right ventricular dysfunction at presentation, or posterior defects, and those undergoing emergent VSR correction have increased odds of operative mortality.
Authors: Daniele Ronco; Matteo Matteucci; Mariusz Kowalewski; Michele De Bonis; Francesco Formica; Federica Jiritano; Dario Fina; Thierry Folliguet; Nikolaos Bonaros; Claudio Francesco Russo; Sandro Sponga; Igor Vendramin; Carlo De Vincentiis; Marco Ranucci; Piotr Suwalski; Giosuè Falcetta; Theodor Fischlein; Giovanni Troise; Emmanuel Villa; Guglielmo Actis Dato; Massimiliano Carrozzini; Giuseppe Filiberto Serraino; Shabir Hussain Shah; Roberto Scrofani; Antonio Fiore; Jurij Matija Kalisnik; Stefano D'Alessandro; Vittoria Lodo; Adam R Kowalówka; Marek A Deja; Salman Almobayedh; Giulio Massimi; Matthias Thielmann; Bart Meyns; Fareed A Khouqeer; Nawwar Al-Attar; Matteo Pozzi; Jean-François Obadia; Udo Boeken; Nikolaos Kalampokas; Carlo Fino; Caterina Simon; Shiho Naito; Cesare Beghi; Roberto Lorusso Journal: JAMA Netw Open Date: 2021-10-01