Abstract 10813: Transcatheter Closure versus Surgical Closure of Post-Infarction Ventricular Septal Defect
BACKGROUND: The repair of post-infarction ventricular septal defect (InfarctVSD) is still a challenge. We compare transcatheter closure (TCC) with surgical closure of infarctVSD in this setting to find out the best time for each intervention.
METHODS: Fifty-seven patients who underwent surgical closure of infarctVSD at our hospital were compared with 159 patients treated by TCC, 154 of them reported by published papers and 5 treated at our hospital.
RESULTS: TCC was feasible in 146 patients (91%). The patients were divided into four groups: cardiogenic shock and/or TCC within the 1st post-infarction week (group I, n=50), TCC between 1st und 3rd post-infarction week (group II, n=29), treatment after the 3rd week (group III n=29), and secondary TCC after primary surgical closure (group IV, n=38). The in-hospital mortality in the groups I, II, III and IV was 86%, 24%, 0% and 2.6% respectively. Lethal periprocedural complications were found in 11.3% of the patients. In comparison, in our surgical group the in-hospital mortality was 37.5%. The mortality in patients with cardiogenic shock and/or treated within the 1st post-infarction week (n=30) was 43% and significantly lower (p< 0.05) than in group I of the TCC collective.
CONCLUSIONS: Our results support a new algorithm for the management of infarctVSD, as TCC of infarctVSD in patients in the acute phase and/or in cardiogenic shock does not improve survival. Transcatheter closure is an option in stable patients both later than 3 weeks post infarction and as treatment of residual VSD after primary surgical closure.
- © 2011 by American Heart Association, Inc.