Pojar Marek, Harrer Jan, Omran Nedal, Turek Zdenek, Striteska Jana, Vojacek Jan
Faculty of Medicine, Department of Cardiac Surgery, Charles University, University Hospital in Hradec Kralove, Hradec Kralove, Czech Republic.
Faculty of Medicine, Department of Anesthesiology, Resuscitation and Intensive Medicine, Charles University, University Hospital in Hradec Kralove, Hradec Kralove, Czech Republic.
Interact Cardiovasc Thorac Surg. 2018 Jan 1;26(1):41-46. doi: 10.1093/icvts/ivx230.
Postinfarction ventricular septal defect is a serious mechanical complication of acute myocardial infarction associated with high postoperative mortality. The aim of this study was to review our experience with surgical repair of postinfarction ventricular septal defect and to identify predictors of early and late outcomes.
Thirty-nine patients (19 men and 20 women, mean age 68.4 ± 9.9 years) with postinfarction ventricular septal defect who underwent surgical repair at our institution between 1996 and 2016 were retrospectively evaluated. Risk factors were assessed by univariate analysis, with those found significant included in multivariate analysis.
The ventricular septal defect was anterior in 21 (54%) patients and posterior in 18 (46%) patients. Mean aortic cross-clamp time was 91.8 ± 26.8 min, and mean cardiopulmonary bypass time was 146.3 ± 49.7 min. Twelve (31%) patients underwent concomitant coronary artery bypass grafting. The 30-day mortality rate was 36% (n = 14). The 30-day survival rate was higher with than without concomitant coronary artery bypass grafting (83% vs 56%), but concomitant coronary artery bypass grafting did not influence late survival (P = 0.098). Univariate analysis identified age, emergency surgery, inotropic support, Killip class, preoperative aspartate aminotransferase concentration, renal replacement therapy and ventricular septal defect diagnosis to operation interval as predictors of 30-day mortality. However, multivariate analysis showed that age and renal replacement therapy were the only independent risk factors of 30-day mortality.
Surgical repair of postinfarction ventricular septal defect has a high 30-day mortality rate. Higher age at presentation and postoperative renal replacement therapy are independent predictors of early mortality.
心肌梗死后室间隔缺损是急性心肌梗死严重的机械性并发症，术后死亡率高。本研究旨在回顾我们对心肌梗死后室间隔缺损手术修复的经验，并确定早期和晚期预后的预测因素。
回顾性评估1996年至2016年在我院接受手术修复的39例心肌梗死后室间隔缺损患者（19例男性，20例女性，平均年龄68.4±9.9岁）。通过单因素分析评估危险因素，将有统计学意义的因素纳入多因素分析。
21例（54%）患者的室间隔缺损位于前方，18例（46%）患者的室间隔缺损位于后方。平均主动脉阻断时间为91.8±26.8分钟，平均体外循环时间为146.3±49.7分钟。12例（31%）患者同期行冠状动脉旁路移植术。30天死亡率为36%（n = 14）。同期行冠状动脉旁路移植术患者的30天生存率高于未同期行冠状动脉旁路移植术患者（83%对56%）, 但同期行冠状动脉旁路移植术对晚期生存率无影响（P = 0.098）。单因素分析确定年龄、急诊手术、血管活性药物支持、Killip分级、术前天冬氨酸转氨酶浓度、肾脏替代治疗及室间隔缺损诊断至手术间隔时间为30天死亡率的预测因素。然而，多因素分析显示年龄和肾脏替代治疗是30天死亡率的唯一独立危险因素。
心肌梗死后室间隔缺损手术修复的30天死亡率较高。就诊时年龄较大及术后肾脏替代治疗是早期死亡率的独立预测因素。
