Ventricular septal defect (VSD) is a rare but life-threatening complication of acute myocardial infarction (MI). It is a new tear between the left and right ventricles that exposes it to systemic pressures. About 94% of patients die within a month if it is left alone without repair and only medical therapy.
A new study looks at post-MI ventricular septal defect repair strategies in real-world practice. MedPage Today reported that this is the first registry study to compare percutaneous versus surgical repair, which showed a significant difference in the survival rate with an unclear impact on long-term outcomes.
What is Post-MI Ventricular Septal Defect?
According to the Centers for Disease Control and Prevention (CDC), is a birth defect of the heart in which there is a hole in the wall or ventricular septum that separates the two chambers of the heart.
A baby without a congenital heart defect has a normal heart in which its right side pumps oxygen-poor blood from the heart to the lungs and the left side pumps oxygen-rich blood to the whole body.
In babies with VSD, blood often flows from the left ventricle through the VSD to the right ventricle and into the lungs, giving extra blood to be pumped by the lungs and forcing both heart and lungs to work harder. If it is not repaired, it could increase the risk of other complications, such as heart failure, pulmonary hypertension, arrhythmia, and stroke.
But VSD could also happen after a heart attack, which is known as post-MI VSD. A 2016 paper showed that it is an increasingly rare complication of heart attack that develops within a few days after transmural myocardial infarction that involves the septum.
Mortality associated with post-MI VSD is high, wherein there is a 94% mortality rate, while strategy involving surgery is associated with 47% mortality during the first month. Making a decision to perform surgery is complicated because of the patient's preoperative condition and the softness of the tissues affected by necrosis.
Percutaneous Vs. Surgery
Researchers of the first registry study cited by MedPage Today looked at a few hundred cases to compare percutaneous versus surgical repair of post-MI VSD. The study shows that 5-year-all-cause mortality is about 60% in patients assigned an initial management strategy of surgery and those undergoing percutaneous treatment.
Landmark analysis from hospital discharge shows that there are no long-term differences in survival of the two strategies despite the in-hospital mortality rates of the percutaneous group which puts it at a disadvantage.
Cardiogenic shock was identified as the strongest predictor of 5-year mortality upon multivariable adjustment, says Dr. Joel Peter Giblett of Liverpool Heart and Chest Hospital in England.
He added that both strategies are complementary in real-world and clinical practice that offers a significant advantage in surviving post-MI VSD compared to historical data on medical therapy. "Shared decision-making through the heart team is key for patients," MedPage Today quoted Gilbett.
The choice between percutaneous and surgery should depend on the individual situation of the hospital and whether they have experienced specialists for each approach.
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