Adult Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Adult Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ann Thorac Surg. 2019 Oct;108(4):1127-1132. doi: 10.1016/j.athoracsur.2019.03.101. Epub 2019 May 7.
The outcomes of surgical treatment of ventricular septal rupture (VSR) complicating acute myocardial infarction are worse in patients with cardiogenic shock. This study aimed to identify clinical characteristics and outcomes in patients with VSR presenting with cardiogenic shock.
A retrospective analysis was performed in 105 consecutive VSR patients, 71 with cardiogenic shock (67.6%) and 34 without cardiogenic shock (32.4%), who underwent surgical treatment in the Department of Adult Cardiac Surgery of Fuwai Hospital between January 2002 and December 2017. Baseline characteristics and outcomes in patients with VSR with and without cardiogenic shock were assessed.
There were no differences in hypertension, diabetes, history of myocardial infarction, body mass index, or location of VSR between patients with and without cardiogenic shock. The size of VSR was larger in patients with cardiogenic shock than in those without (18.2 ± 8.1 mm vs 14.0 ± 7.8 mm; P = .013). Intraaortic balloon pump was required more in patients with cardiogenic shock before operation (39 [68.4%] vs 1 [5.0%]; P < .001]. More emergency surgeries were performed in the cardiogenic shock group (21 [29.6%] vs 3 [8.8%]; P = .018). There were 3 in-hospital deaths among patients with VSR with cardiogenic shock. After 76.56 ± 47.78 months of follow-up, only 2 noncardiac deaths were documented.
The larger the ventricular septal rupture is, the more prone patients are to develop cardiogenic shock. Surgical treatment outcomes for VSR with cardiogenic shock are satisfactory.
在合并心源性休克的急性心肌梗死患者中，外科手术治疗室间隔破裂（VSR）的结局更差。本研究旨在确定伴有心源性休克的 VSR 患者的临床特征和结局。
回顾性分析 2002 年 1 月至 2017 年 12 月期间在阜外医院成人心脏外科接受手术治疗的 105 例连续 VSR 患者，其中 71 例合并心源性休克（67.6%），34 例不合并心源性休克（32.4%）。评估 VSR 伴和不伴心源性休克患者的基线特征和结局。
心源性休克组和无心源性休克组患者在高血压、糖尿病、心肌梗死史、体重指数或 VSR 部位方面无差异。心源性休克组的 VSR 较大（18.2 ± 8.1mm 比 14.0 ± 7.8mm；P =.013）。心源性休克患者术前更需要主动脉内球囊泵（39 例[68.4%]比 1 例[5.0%]；P <.001）。心源性休克组更常进行急诊手术（21 例[29.6%]比 3 例[8.8%]；P =.018）。心源性休克伴 VSR 患者中有 3 例院内死亡。76.56 ± 47.78 个月的随访后，仅记录到 2 例非心脏死亡。
VSR 越大，患者越容易发生心源性休克。伴有心源性休克的 VSR 的外科治疗结局令人满意。
