Percutaneous Closure of Post-Infarction Ventricular Septal Defect: In-Hospital Outcomes and Long-Term Follow-Up of UK Experience
Background—Post-infarction ventricular septal defect (PIVSD) carries a grim prognosis. Surgical repair offers reasonable outcomes in patients who survive a healing phase. Percutaneous device implantation represents a potentially attractive early alternative.
Methods and Results—PIVSD closure was attempted in 53 patients from 11 centers (1997-2012) (age 72±11 years; 42% female). 19% had previous surgical closure. Myocardial infarction (MI) was anterior (66%) or inferior (34%). Time from MI to closure procedure was 13 [Q1-Q3: 5-54] days. Devices were successfully implanted in 89% of patients. Major immediate complications included procedural death (3.8%) and emergency cardiac surgery (7.5%). Immediate shunt reduction was graded as complete (22%), partial (63%) or none (16%). Median length of stay post-procedure was 5.0 [2.0-9.0] days. 58% survived to discharge and were followed up for 395 [63-1522] days, during which time four further patients died (7.5%). Factors associated with death following PIVSD closure included: age (HR=1.04, p=0.039), female sex (HR=2.33, p=0.043), NYHA class IV (HR=4.42, p=0.002), cardiogenic shock (HR=3.75, p=0.003), creatinine (HR=1.007, p=0.003), defect size (HR=1.09, p=0.026), inotropes (HR=4.18, p=0.005) and absence of revascularization therapy for presenting MI (HR=3.28, p=0.009). Prior surgical closure (HR=0.12, p=0.040) and immediate shunt reduction (HR=0.49, p=0.037) were associated with survival.
Conclusions—Percutaneous closure of PIVSD is a reasonably effective treatment for these extremely high-risk patients. Mortality remains high but patients who survive to discharge do well in the longer term.
- postmyocardial infarction ventricular septal defect
- percutaneous closure
- myocardial infarction
- Amplatzer device
- Received August 28, 2013.
- Revision received March 12, 2014.
- Accepted March 21, 2014.