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Management of post-myocardial infarction ventricular septal defects: A critical assessment. [Review]

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Citation: Journal of Interventional Cardiology. 31(6):939-948, 2018 Dec.PMID: 30318677Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: *Cardiac Surgical Procedures/sn [Statistics & Numerical Data] | *Heart Septal Defects, Ventricular/th [Therapy] | *Myocardial Infarction/co [Complications] | *Septal Occluder Device/sn [Statistics & Numerical Data] | Adult | Aged | Heart Septal Defects, Ventricular/et [Etiology] | Heart Septal Defects, Ventricular/mo [Mortality] | Humans | Middle Aged | Myocardial Infarction/mo [Mortality] | Myocardial Infarction/th [Therapy] | Survival Rate | Treatment OutcomeYear: 2018 ISSN:

0896-4327

Name of journal: Journal of interventional cardiologyAbstract: BACKGROUND: Post-myocardial infarction (MI) ventricular septal defects (PIVSD) are an uncommon but life-threatening complication of acute MI. Although surgical closure has been the standard of care, mortality, and recurrence of VSD remain high even after emergent surgery. Transcatheter VSD closure (TCC) devices have become an alternative or adjunct to surgical closure.CONCLUSION: Closure of PIVSD decreases mortality as compared with MT alone and should be attempted as early as possible after diagnosis. Selection of TCC versus SC should be based on factors including complexity of the defect, availability of closure devices, expertise of the operator, and clinical condition of patient.Copyright (c) 2018 Wiley Periodicals, Inc.METHODS: Online database search was performed for studies that included adults with PIVSD who underwent medical treatment (MT) alone, surgical closure (SC) (early or late), and TCC (early, late, or for post-surgical residual VSD).RESULTS: Twenty-six studies were included with a total of 737 patients who underwent either MT (N = 100), SC (early (n = 167), late (n = 100)), and TCC (early (n = 176), late (n = 115), or post-surgical residual VSD (n = 79)). The 30-day mortality among MT group was 92 +/- 6.3%, among SC was 61 +/- 22.5% (early 56 +/- 23%, late 41 +/- 30%), and for all TCC patients was 33 +/- 24% (early 54 +/- 32.7%, late 16 +/- 26%), and TCC for post-surgical residual VSD 11 +/- 34.9%. The mortality among overall SC, overall TCC and early TCC groups was significantly lower as compared with the MT (P < 0.001 for all comparisons). The overall mortality among all TCC, and late TCC groups was significantly lower when compared with the late SC (P < 0.0001, P < 0.0001, respectively).All authors: Beohar N, Egbe AC, Kherada N, Morgan GL, Omar S, Panchal HB, Patel R, Rihal CS, Thourani VFiscal year: FY2019Digital Object Identifier:

https://dx.doi.org/10.1111/joic.12556

Date added to catalog: 2018-11-02

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Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	30318677	Available		30318677

BACKGROUND: Post-myocardial infarction (MI) ventricular septal defects (PIVSD) are an uncommon but life-threatening complication of acute MI. Although surgical closure has been the standard of care, mortality, and recurrence of VSD remain high even after emergent surgery. Transcatheter VSD closure (TCC) devices have become an alternative or adjunct to surgical closure.

CONCLUSION: Closure of PIVSD decreases mortality as compared with MT alone and should be attempted as early as possible after diagnosis. Selection of TCC versus SC should be based on factors including complexity of the defect, availability of closure devices, expertise of the operator, and clinical condition of patient.

METHODS: Online database search was performed for studies that included adults with PIVSD who underwent medical treatment (MT) alone, surgical closure (SC) (early or late), and TCC (early, late, or for post-surgical residual VSD).

RESULTS: Twenty-six studies were included with a total of 737 patients who underwent either MT (N = 100), SC (early (n = 167), late (n = 100)), and TCC (early (n = 176), late (n = 115), or post-surgical residual VSD (n = 79)). The 30-day mortality among MT group was 92 +/- 6.3%, among SC was 61 +/- 22.5% (early 56 +/- 23%, late 41 +/- 30%), and for all TCC patients was 33 +/- 24% (early 54 +/- 32.7%, late 16 +/- 26%), and TCC for post-surgical residual VSD 11 +/- 34.9%. The mortality among overall SC, overall TCC and early TCC groups was significantly lower as compared with the MT (P < 0.001 for all comparisons). The overall mortality among all TCC, and late TCC groups was significantly lower when compared with the late SC (P < 0.0001, P < 0.0001, respectively).

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