Cardiac Surgery Department, INCOR - Heart Institute, University of Sao Paulo, São Paulo, SP, Brazil.
J Card Surg. 2021 Jul;36(7):2253-2262. doi: 10.1111/jocs.15526. Epub 2021 Apr 8.
Ventricular septal rupture (VSR) is a serious mechanical complication after acute coronary syndrome and is related to high mortality. Even with advances in the management of acute myocardial infarction (AMI) such as reperfusion therapies, complication rates are still high. During quarantine, patients presenting mechanical complications after AMI have increased in our institution.
From a retrospective database analysis in our institution between the years 2004 and 2020, we identified 37 cases of VSR after AMI. Four chronic cases were excluded from our analysis. The primary endpoint was to identify baseline characteristics that increased 30-day mortality.
Among 33 acute cases of VSR, 24 cases were submitted to surgery. The 30-day mortality of the operated patients was 45.8%. From 2004 to 2019 our average number of operations of VSR was 1.9 cases/year with an increase to 4 cases/year in 2020. Diabetes mellitus, age, cardiogenic shock, and use of intra-aortic balloon pump were associated with significantly increased mortality using logistic regression.
We reported an increased number of mechanical complication cases from April to September 2020, compared to our historical records. Despite therapeutic advances, mortality rates remain high. Although the number of cases is small to conclude that the pandemic was responsible for this augmentation, we believe that it is related to the decreased number of patients seeking medical assistance.
室间隔破裂（VSR）是急性冠状动脉综合征后的一种严重机械并发症，与高死亡率相关。即使急性心肌梗死（AMI）的治疗有了进展，如再灌注治疗，并发症发生率仍然很高。在隔离期间，我们医院AMI 后出现机械并发症的患者有所增加。
我们对 2004 年至 2020 年在我们机构的回顾性数据库分析中，确定了 37 例 AMI 后 VSR 病例。有 4 例慢性病例被排除在我们的分析之外。主要终点是确定增加 30 天死亡率的基线特征。
在 33 例急性 VSR 病例中，有 24 例接受了手术。手术患者的 30 天死亡率为 45.8%。从 2004 年到 2019 年，我们每年 VSR 手术的平均例数为 1.9 例，而 2020 年增加到 4 例。使用逻辑回归，糖尿病、年龄、心源性休克和使用主动脉内球囊泵与死亡率显著增加相关。
与我们的历史记录相比，我们报告了 2020 年 4 月至 9 月机械并发症病例数的增加。尽管治疗有所进展，但死亡率仍然很高。尽管病例数较少，无法得出大流行是导致这种增加的原因，但我们认为这与寻求医疗帮助的患者数量减少有关。
