Department of Cardiology, Rawalpindi Institute of Cardiology, Rawal Road, Rawalpindi, Pakistan.
Department of Community Medicine, National University of Medical Sciences, Rawalpindi, Pakistan.
PLoS One. 2021 Aug 18;16(8):e0256377. doi: 10.1371/journal.pone.0256377. eCollection 2021.
The effectiveness of deferred surgical repair of ventricular septal rupture (VSR) post-myocardial infarction (MI) with cardiogenic shock remains limited to case reports. Our study aimed to investigate the outcomes and survival analysis following mechanical circulatory support (MCS) in patients after VSR who develop cardiogenic shock.
We analyzed 27 patients with post-MI VSR and cardiogenic shock who received deferred surgical repair while stabilized on MCS between January 2018 and March 2020. After normality test adjustments, continuous variables were expressed as mean ± standard deviation (SD). These were compared using the Mann-Whitney U test and Student's t-test. Categorical variables were compared using chi-square or Fisher's exact test. To identify predictors of operative mortality, univariate analysis of clinical characteristics and interventions followed by logistic regression was carried out. P-value of < 0.05 was considered significant.
All patients had preoperative MCS. Emergency repair was avoided in all the patients. The mean age of the participants was 64.96 with the majority being males (74.1%). On average, the mean time from MI to VSR repair was 18.85 days. Delayed revascularization was associated with increased mortality (OR 17.500, 95% CI 2.365-129.506, P = 0.005). Other factors associated with increased mortality were ejection fraction (EF), three-vessel disease, Killip class, early surgery, and prolonged use of inotropes. The operative mortality was 11% with an overall mortality of 33.3%. The one-year survival rate was 66.7%.
The use of MCS in adjunct to a deferred surgical approach shows an improved survival outcome of patients with VSR complicated by cardiogenic shock. Further investigations are required regarding the optimal time for MCS and surgical repair.
心肌梗死后并发心源性休克的室间隔破裂（VSR）的延迟手术修复效果仍然局限于病例报告。我们的研究旨在探讨机械循环支持（MCS）后并发心源性休克的 VSR 患者接受延迟手术修复的结果和生存分析。
我们分析了 2018 年 1 月至 2020 年 3 月期间，在接受 MCS 稳定治疗的同时，接受延迟手术修复的 27 例心肌梗死后并发 VSR 并发心源性休克的患者。经过正态性检验调整后，连续变量用平均值±标准差（SD）表示。采用 Mann-Whitney U 检验和学生 t 检验进行比较。分类变量采用卡方检验或 Fisher 确切检验进行比较。采用单因素分析临床特征和干预措施，然后进行逻辑回归，确定手术死亡率的预测因素。P 值<0.05 被认为有统计学意义。
所有患者均接受术前 MCS。所有患者均避免了急诊修复。参与者的平均年龄为 64.96 岁，其中大多数为男性（74.1%）。从心肌梗死到 VSR 修复的平均时间为 18.85 天。延迟再血管化与死亡率增加相关（OR 17.500，95%CI 2.365-129.506，P=0.005）。其他与死亡率增加相关的因素包括射血分数（EF）、三血管疾病、Killip 分级、早期手术和儿茶酚胺类药物的长时间使用。手术死亡率为 11%，总死亡率为 33.3%。一年生存率为 66.7%。
MCS 的使用与延迟手术方法相结合，可改善并发心源性休克的 VSR 患者的生存结果。需要进一步研究确定 MCS 和手术修复的最佳时机。
