Post AMI Ventricular Septal Defect: Contemporary Results of Endovascular vs Surgical Repair

In the era of endovascular intervention, with shorter revascularization times, we see lower rates of mechanical complications due to acute myocardial infarction (AMI). Increased rates were recorded during the COVID-19 pandemic, but driven by delays in consultation. 

Comunicación interventricular post IAM: Resultados contemporáneos del tratamiento endovascular vs quirúrgico

Though occasional (with an estimated incidence of 0.2%), post AMI ventricular septal defect (VSD), or interventricular communication, involves high mortality.  Ischemic VSD will produce ischemia related disorders in addition to mechanically compromising the left-right shunt. Surgical repair with patch has been the preferred strategy for many years, though percutaneous closure is a valid strategy increasingly being used. 

This observational retrospective study of a registry in the UK gathered data from patients with post AMI VSD since 2010, aiming at comparing inhospital vs long term mortality. 

Data from 362 patients treated for post AMI VSD were in looked at, 231 were treated with surgery (93.4% patch) and 131 percutaneously (64% use of Amplatzer). Overall, patients treated with closure devices were older (72 vs 67 years; P<0.001) and had higher BMI (28 vs 26 kg/m2; P=0.01). On the other hand, surgical patients presented larger septum defects (18 vs 20mm, P<0.001) and were more often diagnosed with cardiogenic shock (51.9% vs 62.8%, P=0.044). 

Read also: Stent Thrombosis: Clinical Characteristics and Event Predictors in a Contemporary Cohort.

13% of patients treated percutaneously required an additional procedure (either surgical or percutaneous). Also, there was high crossover: 15% of endovascular patients required surgery and 7.4% of surgical patients required a closure device. 

In hospital mortality was 48.1%, with more events in the endovascular arm (55% vs 44.2%, P=0.048), whereas 5-year mortality saw no significant differences (61.1% vs 53.7%, P=0.17). Independent factors associated with mortality were cardiogenic shock (aHR 1.97, CI 95% 1.37-2.84; P<0.001) and initial percutaneous approach (aHR 1.44, CI 95% 1.01-2.05, P=0.042).

Conclusions

This study has shown that, despite the latest technological advance, mortality associated to ischemic VSD remains high, regardless the strategy. This study presents limitations because of high crossover. These patients should be treated either surgical or percutaneously, seeing as medical treatment alone rendered nearly 94% mortality rate.

Dr. Omar Tupayachi

Dr. Omar Tupayachi.
Member of the Editorial Board of SOLACI.org.

Original Title: Post-infarction ventricular septal defect: percutaneous or surgical management in the UK national registry.

Reference: Giblett, Joel P et al. “Post-infarction ventricular septal defect: percutaneous or surgical management in the UK national registry.” European heart journal, ehac511. 17 Sep. 2022, doi:10.1093/eurheartj/ehac511.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

Spontaneous Left Main Dissection: Clinical Characteristics, management and Outcomes

Courtesy of Dr. Juan Manuel Pérez. Spontaneous left main dissection in an uncommon, and potentially life-threatening, cause of acute MI. The aim of this study,...

Pretreatment with DAPT in Acute Coronary Syndrome: An Ongoing Debate?

In acute coronary syndrome (ACS) dual antiplatelet therapy (DAPT) has become a fundamental pillar after percutaneous coronary intervention (PCI), preventing stent thrombosis and acute...

Another Blow for Intra-Aortic Balloon Pumo Counterpulsation? Randomized Study on Its Use in Chronic Heart Failure Progressing to Cardiogenic Shock

Cardiogenic shock (CS) remains a condition with extremely high mortality (around 50%). While most therapies for this pathology have been studied in CS secondary...

Radial Patency in Coronary Procedures: Is Heparin Enough or Should We Aim for Distal Transradial Access?

Transradial access is the preferred route in most coronary procedures due to its proven reduction in mortality compared to transfemoral access. However, one of...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Percutaneous Treatment of Atrial Functional Mitral Regurgitation

Atrial functional mitral regurgitation (aFMR), which results from atrial dilation without significant left ventricular dysfunction, accounts for approximately one-third of mitral regurgitation (MR) cases...

ACURATE Neo2 Underexpansion: Prevalence and Clinical Implications

While transcatheter aortic valve replacement (TAVR) provides durable clinical benefits across a wide range of patients, technical challenges remain that may affect long-term outcomes....

Spontaneous Left Main Dissection: Clinical Characteristics, management and Outcomes

Courtesy of Dr. Juan Manuel Pérez. Spontaneous left main dissection in an uncommon, and potentially life-threatening, cause of acute MI. The aim of this study,...