Horan Dylan P, O'Malley Thomas J, Weber Matthew P, Maynes Elizabeth J, Choi Jae Hwan, Patel Sinal, Challapalli Jothika, Luc Jessica G Y, Entwistle John W, Todd Massey H, Morris Rohinton J, Tchantchaleishvili Vakhtang
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
J Card Surg. 2020 May;35(5):1062-1071. doi: 10.1111/jocs.14515. Epub 2020 Apr 1.
Ventricular septal defect (VSD) following myocardial infarction (MI) is a relatively infrequent complication with high mortality. We sought to investigate the effect of concomitant coronary artery bypass graft (CABG) on outcomes following post-MI VSD repair.
Electronic search was performed to identify all relevant studies published from 2000 to 2018. Sixty-seven studies were selected for the analysis comprising 2174 patients with post-MI VSD. Demographic information, perioperative variables, and outcomes including survival data were extracted and pooled for systematic review and meta-analysis.
Single-vessel disease was most common (47%, 95% confidence interval [CI], 42-52), left anterior descending coronary artery was the most commonly involved vessel (55%, 95% CI, 46-63), and anterior wall was the most commonly affected territory (57%, 95% CI, 51-63). Concomitant CABG was performed in 52% (95% CI, 46-57) of patients. Of these, infarcted territory was re-vascularized in 54% (95% CI, 23-82). A residual/recurrent shunt was present in 29% (95% CI, 24-34) of patients. Of these, surgical repair was performed in 35% (95% CI, 28-41) and transcatheter repair in 11% (95% CI, 6-21). Thirty-day mortality was 30% (95% CI, 26-35) in patients who had preoperative coronary angiogram, and 58% (95% CI, 43-71) in those who did not (P < .01). No significant survival difference observed between those who had concomitant CABG vs those without CABG.
Concomitant CABG did not have a significant effect on survival following VSD repair. Revascularization should be weighed against the risks associated with prolonged cardiopulmonary bypass.
心肌梗死（MI）后室间隔缺损（VSD）是一种相对少见但死亡率较高的并发症。我们试图研究冠状动脉旁路移植术（CABG）对心肌梗死后室间隔缺损修复术后结局的影响。
进行电子检索以识别2000年至2018年发表的所有相关研究。选择67项研究进行分析，包括2174例心肌梗死后室间隔缺损患者。提取人口统计学信息、围手术期变量以及包括生存数据在内的结局，并进行汇总以进行系统评价和荟萃分析。
单支血管病变最为常见（47%，95%置信区间[CI]，42 - 52），左前降支冠状动脉是最常受累血管（55%，95%CI，46 - 63），前壁是最常受累区域（57%，95%CI，51 - 63）。52%（95%CI，46 - 57）的患者接受了同期CABG。其中，梗死区域血运重建率为54%（95%CI，23 - 82）。29%（95%CI，24 - 34）的患者存在残余/复发性分流。其中，35%（95%CI，28 - 41）的患者接受了手术修复，11%（95%CI，6 - 21）的患者接受了经导管修复。术前进行冠状动脉造影的患者30天死亡率为30%（95%CI，26 - 35），未进行冠状动脉造影的患者为58%（95%CI，43 - 71）（P <.01）。同期接受CABG与未接受CABG的患者之间未观察到显著的生存差异。
同期CABG对室间隔缺损修复术后的生存无显著影响。血运重建应权衡与体外循环时间延长相关的风险。
