Talukder Q I, Rahman M H, Azad A K, Rahman M Z, Chanda P K, Ahmed F
Dr M Quamrul Islam Talukder, Associate Professor & Senior Consultant, Department of Cardiac Surgery, National Heart Foundation Hospital & Research Institute, Mirpur, Dhaka, Bangladesh.
Mymensingh Med J. 2018 Oct;27(4):746-751.
To review the experience of surgical repair of post-infarction ventricular septal rupture (VSR) and analyze the associated outcomes in National Heart Foundation Hospital & Research Institute (NHFH & RI). This retrospective review was performed on 19 consecutive cases who had undergone surgical repair of post-infarction VSR between 2009 and 2017. Continuous variables were summarized as mean plus/minus the standard deviation or median. Categorical variables were expressed as percentage of the sample. Comparison between in-hospital survivors versus non-survivors was performed by Student's t-test and chi-square or Fisher's exact test for continuous and categorical variables respectively. A value of p<0.05 was considered statistically significant. Mean age of survivor and non-survivors were 53.53±9.2 and 56.33±1.5 years consecutively. Anterior VSR 14(73.6%) was more common than posterior VSR 5(26.4%). All patients had significant coronary lesions; the frequency of 1-, 2-, and 3-vessel disease was 22.2%, 27.7% and 50.0% consecutively. The left anterior descending coronary artery was the infarct-related artery in all patients with anterior VSR. Mean cardiopulmonary bypass time was 157±58.6 minutes and 249±78.3 minutes in survivor and non-survivor groups consecutively (p=0.018). Operative mortality within 30 days was 21%. Low output syndrome (LOS), multiple organ failure (MOF), septicemia, tracheostomy and prolonged intensive care unit (ICU) stay were the major factor for survivals. Surgical repair of post-infarction VSR carries a high operative mortality. But, stable hemodynamic at the time of VSR diagnosis is a significant predictor of survival and concomitant coronary artery bypass grafting (CABG) improves early survival.
回顾国家心脏基金会医院及研究所（NHFH & RI）对心肌梗死后室间隔破裂（VSR）进行手术修复的经验，并分析相关结果。对2009年至2017年间连续19例接受心肌梗死后VSR手术修复的病例进行了回顾性研究。连续变量总结为均值加减标准差或中位数。分类变量以样本的百分比表示。分别通过学生t检验和卡方检验或Fisher精确检验对住院幸存者和非幸存者的连续变量和分类变量进行比较。p值<0.05被认为具有统计学意义。幸存者和非幸存者的平均年龄分别为53.53±9.2岁和56.33±1.5岁。前壁VSR 14例（73.6%）比后壁VSR 5例（26.4%）更常见。所有患者均有严重冠状动脉病变；单支、双支和三支血管病变的发生率分别为22.2%、27.7%和50.0%。所有前壁VSR患者的梗死相关动脉均为左前降支冠状动脉。幸存者组和非幸存者组的平均体外循环时间分别为157±58.6分钟和249±78.3分钟（p=0.018）。30天内手术死亡率为21%。低心排血量综合征（LOS）、多器官功能衰竭（MOF）、败血症、气管切开术和延长的重症监护病房（ICU）停留时间是影响生存的主要因素。心肌梗死后VSR的手术修复具有较高的手术死亡率。但是，VSR诊断时血流动力学稳定是生存的重要预测因素，同期冠状动脉旁路移植术（CABG）可提高早期生存率。
