Interventional post-myocardial infarction ventricular septal defect closure: a systematic review of current evidence.

AIMS

Interventional closure of post-myocardial infarction ventricular septal defects (VSD) is an alternative treatment option to surgical repair. However, only limited evidence exists concerning the interventional closure of a VSD. This review seeks to establish an overview of the existing literature and to carry out a systematic analysis of the success rate and clinical outcome of this procedure.

METHODS AND RESULTS

We conducted a comprehensive systematic literature search to evaluate the existing evidence of percutaneous device closure of post-infarction VSD. Patient series with fewer than five reported cases were excluded. In total, 13 series were identified, with an overall inclusion of 273 patients. Mean patient age was 70 years. Cardiogenic shock was present in 48% of cases at the time of intervention. Device closure within the first 14 days (acute phase) after VSD detection was performed in 42% of cases. Technical success rate was high (>75%). Successful device implantation rate was 89%. Overall in-hospital/30-day mortality was 32%. Major complications included device embolisation, ventricular perfora-tion and arrhythmias.

CONCLUSIONS

Percutaneous device closure of post-myocardial infarction VSD is a valuable alternative to surgical repair, with the advantage of immediate shunt reduction to prevent haemodynamic deterioration. A high rate of technically successful percutaneous procedures can be achieved; however, the mortality rate remains high, especially in cardiogenic shock patients.