Khan Muhammad Yasir, Waqar Tariq, Qaisrani Perisa Gul, Khan Adnan Zafar, Khan Muhammad Shahrukh, Zaman Haider, Jalal Anjum
Dr. Muhammad Yasir Khan, MCPS, FCPS(G.S), FCPS(C.S), MRCS. Department of Cardiac Surgery, Ch. Pervaiz Elahi Institute of Cardiology, Multan, Pakistan.
Dr. Tariq Waqar, FCPS, FRCS Department of Cardiac Surgery, Ch. Pervaiz Elahi Institute of Cardiology, Multan, Pakistan.
Pak J Med Sci. 2018 Jan-Feb;34(1):20-26. doi: 10.12669/pjms.341.13906.
Ventricular septal rupture (VSR) is one of the fatal complications of myocardial infarction (MI). Surgery provides the maximum survival benefit. Our objective was to investigate the risk factors of surgical mortality and to do the survival analysis in the past six years at our hospital.
All the patients operated at CPE Institute of Cardiology Multan Pakistan, between 2009 and 2015 for repair of post MI VSR were analysed retrospectively for demographics, comorbidities, operative and post operative outcomes. The primary outcome was 30 days mortality. The follow up was done till April 2017 and the follow up data was obtained from hospital records and by telephoning the patients. SPSS was used for statistical analysis. P value < 0.05 was considered significant.
A total of 31 patients were operated for VSR repair with a mean age of 57.19±7.73 years. Eighteen patients also had a concomitant coronary artery bypass grafting (CABG). The operative mortality in this series was 25.8% Univariate analysis showed that pre-operative ejection fraction (E.F) (p value 0.010) and cardiogenic shock (p value 0.031) were a significant risk factors for operative mortality while on logistic regression analysis only the cardiogenic shock was found to be an independent risk factor for operative mortality with the odds ratio of 2.17. Low ejection fraction only acted as a confounding variable. The mean survival at six years was 34 months with a survival rate of 28.6%. The additional CABG did not confer any survival benefit.
The patients in cardiogenic shock pre-operatively have a high operative mortality. Low ejection fraction (E.F) acts as a confounding factor. Concomitant CABG does not confer any survival benefit.
室间隔破裂（VSR）是心肌梗死（MI）的致命并发症之一。手术能带来最大的生存获益。我们的目的是调查手术死亡率的危险因素，并对我院过去六年的患者进行生存分析。
回顾性分析2009年至2015年间在巴基斯坦木尔坦心脏病学CPE研究所接受心肌梗死后室间隔破裂修复手术的所有患者的人口统计学、合并症、手术及术后结果。主要结局是30天死亡率。随访至2017年4月，随访数据来自医院记录并通过电话联系患者获得。使用SPSS进行统计分析。P值<0.05被认为具有统计学意义。
共有31例患者接受了室间隔破裂修复手术，平均年龄为57.19±7.73岁。18例患者同时进行了冠状动脉旁路移植术（CABG）。本系列手术死亡率为25.8%。单因素分析显示，术前射血分数（E.F）（P值0.010）和心源性休克（P值0.031）是手术死亡率的显著危险因素，而多因素逻辑回归分析仅发现心源性休克是手术死亡率的独立危险因素，比值比为2.17。低射血分数仅作为一个混杂变量。六年的平均生存期为34个月，生存率为28.6%。额外的冠状动脉旁路移植术并未带来任何生存获益。
术前发生心源性休克的患者手术死亡率高。低射血分数（E.F）是一个混杂因素。同时进行冠状动脉旁路移植术并未带来任何生存获益。
