Ma Dongliang, Zhang Zhibiao, Zhang Shunye, Wang Zhongchao, Zhang Gang, Wang Chongjun, Xi Jicheng
Department of Cardiovascular Surgery, Shanxi Provincial Cardiovascular Hospital, Shanxi Provincial Institute of Cardiovascular Diseases, Taiyuan, China.
Department of Cardiology, Shanxi Provincial Cardiovascular Hospital, Shanxi Provincial Institute of Cardiovascular Diseases, Taiyuan, China.
Front Cardiovasc Med. 2022 Feb 22;9:843625. doi: 10.3389/fcvm.2022.843625. eCollection 2022.
To analyze treatment strategies, prognosis, and related risk factors of patients with postinfarction ventricular septal rupture, as well as the impact of timing of surgical intervention.
A total of 23 patients diagnosed with postinfarction ventricular septal rupture who were non-selectively admitted to Shanxi Provincial Cardiovascular Hospital between October 2017 and August 2021 were included in this study. The relevant clinical data, operation-related conditions, and follow-up data were summarized for all patients. The Kaplan-Meier method and log-rank test were used for the cumulative incidence of unadjusted mortality in patients with different treatment methods. Multivariate logistic regression was used to evaluate the independent risk factors for in-hospital patient mortality.
The mean age of the study patients was 64.43 ± 7.54 years, 12(52.2%) were females. There was a significant difference in terms of postoperative residual shunt between the surgical and interventional closure groups (5.9 vs. 100%, respectively; < 0.001). The overall in-hospital mortality rate was 21.7%; however, even though the surgical group had a lower mortality rate than the interventional closure group (17.6 vs. 33%, respectively), this difference was not statistically significant ( = 0.576). Univariate analysis showed that in-hospital survival group patients were significantly younger than in-hospital death group patients (62.50 ± 6.53 vs. 71.40 ± 7.37 years, respectively; = 0.016), and that women had a significantly higher in-hospital mortality rate than men ( = 0.037). The average postoperative follow-up time was 18.11 ± 13.92 months; as of the end of the study all 14 patients in the surgical group were alive, Two out of four patients survived and two patients died after interventional closure. Univariate analysis showed that interventional closure was a risk factor for long-term death ( < 0.05).
Surgical operation is the most effective treatment for patients with postinfarction ventricular septal rupture; however, the best timing of the operation should be based on the patient's condition and comprehensively determined through real-time evaluation and monitoring. We believe that delaying the operation time as much as possible when the patient's condition permits can reduce postoperative mortality. Interventional closure can be used as a supplementary or bridge treatment for surgical procedures.
分析心肌梗死后室间隔破裂患者的治疗策略、预后及相关危险因素，以及手术干预时机的影响。
本研究纳入了2017年10月至2021年8月间非选择性入住山西省心血管病医院的23例诊断为心肌梗死后室间隔破裂的患者。总结了所有患者的相关临床资料、手术相关情况及随访数据。采用Kaplan-Meier法和log-rank检验分析不同治疗方法患者的未调整死亡率累积发生率。采用多因素logistic回归分析评估住院患者死亡的独立危险因素。
研究患者的平均年龄为64.43±7.54岁，女性12例（52.2%）。手术封堵组和介入封堵组术后残余分流存在显著差异（分别为5.9%和100%；P<0.001）。总体住院死亡率为21.7%；然而，尽管手术组的死亡率低于介入封堵组（分别为17.6%和33%），但差异无统计学意义（P = 0.576）。单因素分析显示，住院存活组患者比住院死亡组患者显著年轻（分别为62.50±6.53岁和71.40±7.37岁；P = 0.016），女性住院死亡率显著高于男性（P = 0.037）。术后平均随访时间为18.11±13.92个月；截至研究结束，手术组14例患者全部存活，介入封堵组4例患者2例存活，2例死亡。单因素分析显示，介入封堵是长期死亡的危险因素（P<0.05）。
手术治疗是心肌梗死后室间隔破裂患者最有效的治疗方法；然而，最佳手术时机应根据患者病情，通过实时评估和监测综合确定。我们认为，在患者病情允许的情况下，尽可能推迟手术时间可降低术后死亡率。介入封堵可作为手术的补充或过渡治疗。
