Surgery for Post-Myocardial Infarct Ventricular Septal Defect

Abstract

Forty-three patients (mean age 62 .+-. 1 yr) were treated for ventricular septal defect (VSD) secondary to myocardial infarction. Whenever possible, operation was postponed until 6 wk post-onset chest pain. Hemodynamic instability, evidenced by cardiogenic shock, refractory pulmonary edema, or a rising blood urea N (BUN) forced operation in 21 patients within 21 days post-infarct (Group I). In 7 patients operation was performed 3-6 wk post-infarct (Group II). In only 8 patients could operation be delayed beyond 6 wk post-infarct (Group III). Clinical deterioration, once begun, progressed rapidly, and could be reversed only temporarily by intra-aortic balloon pumping, used in 26 patients for safe conduct of cardiac catheterization and for peri-operative hemodynamic support. Hospital survival was achieved in 24 of the 36 operated patients (66%). In Group I patients, 10 of 21 survived. In Group II, 6 of 7 survived. In Group III, 8 of 8 patients survived. There were 5 late deaths with a mean follow-up of 41 mo. in survivors. Improved survival was achieved recently by the greater use of prosthetic material to replace necrotic muscle and by a transinfarct incision regardless of infarct location. Operative mortality before 1973 was 47%; mortality after 1973 was only 18%, with a concomitant reduction of mortality (30%) even in Group I patients.