Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy.
Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy.
Ann Thorac Surg. 2021 Jul;112(1):326-337. doi: 10.1016/j.athoracsur.2020.08.050. Epub 2020 Nov 4.
Ventricular septal rupture (VSR) is a rare but life-threatening complication after acute myocardial infarction. Although surgical correction is challenging and associated with high mortality, it remains the treatment of choice. This systematic review and meta-analysis aimed to evaluate the early outcome of surgical VSR repair.
We searched electronic databases from January 1998 to February 2020. Studies reporting patients undergoing surgical treatment for VSR were analyzed. The primary outcome assessed was operative mortality. Differences were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) to assess the relationships of predefined surgical variables and clinical prognosis.
A total of 6361 adult patients from 41 studies were identified. Operative mortality was 38.2%. Pooled ORs showed increased odds of operative mortality in patients with preoperative or perioperative intraaortic balloon pump insertion (OR = 3.48; 95% CI, 3.01-4.02; P < .001), right ventricular dysfunction (OR = 2.85; 95% CI, 1.47-5.52; P = .002), posterior VSR (OR = 1.73; 95% CI, 1.30-2.31; P < .001), and emergency surgery (OR = 3.79; 95% CI, 2.52-5.72; P < .001). Temporal trend evaluation revealed no difference over time in the operative mortality rate; it was 34% in both time-related groups (1971-2000 versus 2001-2018).
Ventricular septal rupture repair has a high operative mortality. Patients with preoperative or perioperative intraaortic balloon pump support, right ventricular dysfunction at presentation, or posterior defects, and those undergoing emergent VSR correction have increased odds of operative mortality.
室间隔破裂（VSR）是急性心肌梗死后罕见但危及生命的并发症。尽管手术矫正具有挑战性且死亡率高，但它仍然是首选的治疗方法。本系统评价和荟萃分析旨在评估手术 VSR 修复的早期结果。
我们从 1998 年 1 月至 2020 年 2 月检索了电子数据库。分析了报告接受 VSR 手术治疗的患者的研究。评估的主要结果是手术死亡率。差异表示为优势比（OR）和 95%置信区间（CI），以评估术前或围手术期主动脉内球囊泵插入、右心室功能障碍、后 VSR 和急诊手术等预定手术变量与临床预后的关系。
从 41 项研究中确定了 6361 名成年患者。手术死亡率为 38.2%。汇总 OR 显示，术前或围手术期主动脉内球囊泵插入（OR=3.48；95%CI，3.01-4.02；P<.001）、右心室功能障碍（OR=2.85；95%CI，1.47-5.52；P=.002）、后 VSR（OR=1.73；95%CI，1.30-2.31；P<.001）和急诊手术（OR=3.79；95%CI，2.52-5.72；P<.001）患者的手术死亡率增加。时间趋势评估显示，手术死亡率在不同时间段没有差异；在两个时间相关组中均为 34%（1971-2000 年与 2001-2018 年）。
室间隔破裂修复的手术死亡率较高。术前或围手术期主动脉内球囊泵支持、初次就诊时右心室功能障碍或后 VSR 缺陷以及紧急 VSR 矫正的患者手术死亡率增加。
