Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States of America.
Department of Medicine, Duke University Medical Center, Durham, NC, United States of America.
Cardiovasc Revasc Med. 2020 Sep;21(9):1093-1096. doi: 10.1016/j.carrev.2020.02.011. Epub 2020 Feb 13.
Post myocardial infarction ventricular septal defect (VSD) is a rare, but devastating complication which carries a poor prognosis if left untreated. Optimal therapy remains unclear and surgical repair is associated with high mortality.
The aim of our study is to compare 30-day survival in patients with early versus late primary transcatheter repair of post myocardial infarction ventricular septal defect.
We performed a comprehensive search of published data through SCOPUS and identified published reports of primary transcatheter closure of post myocardial infarction VSD. We included case reports and series that reported timing of VSD closure and 30-day survival and excluded those with prior surgical repair. Early repair was defined as transcatheter closure within 14 days of diagnosis of VSD while late repair was defined as transcatheter closure after 14 days of diagnosis of VSD.
A total 27 publications describing 193 patients were identified in the SCOPUS search. We excluded 8 publications with no reported timing of VSD repair or 30-day outcome. Of the 193 patients initially included, a total of 126 patients fulfilled all the criteria and were included in the final analysis. The overall 30-day survival rate was found to be 62.7% (79 patients). In the early repair group, only 36.2% of the patients were still alive at 30 days compared to 85.3% in the delayed repair group, P < .01. No significant difference in age, gender, presence of shock, VSD size, presence of significant residual shunt, location of VSD or infarction was observed. The early repair group was found to have a significantly larger Qp: Qs ratio as well as larger occluder size and lower rate of successful repair.
Compared to the late repair group, the early transcatheter VSD repair group had a larger pre-procedure Qp:Qs and worse 30-day survival. Further studies are needed to determine the optimal timing of transcatheter repair of a post myocardial infarction VSD.
心肌梗死后室间隔缺损（VSD）是一种罕见但严重的并发症，如果不治疗，预后很差。最佳治疗方法仍不清楚，手术修复与高死亡率相关。
本研究旨在比较早期与晚期经皮心肌梗死后 VSD 患者的 30 天生存率。
我们通过 SCOPUS 进行了全面的文献搜索，并确定了已发表的经皮封堵心肌梗死后 VSD 的报告。我们纳入了报告 VSD 封堵时间和 30 天生存率的病例报告和系列研究，并排除了那些有先前手术修复的报告。早期修复定义为 VSD 确诊后 14 天内进行经皮封堵，晚期修复定义为 VSD 确诊后 14 天以上进行经皮封堵。
SCOPUS 搜索共确定了 27 篇描述 193 例患者的文献。我们排除了 8 篇没有报告 VSD 修复时间或 30 天结局的文献。在最初纳入的 193 例患者中，共有 126 例符合所有标准并纳入最终分析。总的 30 天生存率为 62.7%（79 例）。在早期修复组中，只有 36.2%的患者在 30 天内存活，而晚期修复组为 85.3%，P <.01。两组间年龄、性别、休克、VSD 大小、存在显著残余分流、VSD 或梗死部位无显著差异。早期修复组的 Qp:Qs 比值更大，封堵器尺寸更大，修复成功率更低。
与晚期修复组相比，早期经皮 VSD 修复组术前 Qp:Qs 比值更大，30 天生存率更差。需要进一步研究以确定心肌梗死后 VSD 经皮修复的最佳时机。
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