Indicators and predictors of in-hospital mortality and survival in patients with ventricular septal rupture
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PROVIDER: S-EPMC10978188 | biostudies-literature | 2022 Jan
REPOSITORIES: biostudies-literature
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Project description:We present the case of a 60-year-old man who presented with a post-myocardial infarction ventricular septal rupture caused by a delayed presentation of myocardial infarction. Despite revascularization, hemodynamic stability, and a 10-day delay until operative management to allow for tissue healing, the patient experienced a fatal recurrent postoperative ventricular septal rupture. (Level of Difficulty: Beginner.).
| S-EPMC10544302 | biostudies-literature
Project description:Ventricular septal rupture (VSR) is a mechanical complication of acute myocardial infarction (AMI), and its mortality has not decreased significantly in recent decades. However, no clinical model has been developed to predict short-term mortality in patients with post-infarction VSR (PIVSR). This study aimed to develop a nomogram to predict the 30-day mortality by using the clinical characteristics of hospitalized patients with PIVSR. The least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analysis was used to construct a nomogram by R. The model was evaluated by the area under the curve (AUC), calibration curve and decision curve analysis (DCA). The bootstrap method was used to validate the model internally. As a result, a nomogram was constructed by using six variables, including CRRT, mechanical ventilation, PPCI, WBC, PASP and methods of treatment. The AUC of the prediction model was 0.96 (0.93, 0.98). The prediction model was well calibrated. The DCA showed that if the threshold probability was between 15% and 95%, the nomogram model would provide a net benefit. The well-constructed and evaluated nomogram can be beneficial to clinicians to predict the risk of death within 30 days in patients with PIVSR.
| S-EPMC11292003 | biostudies-literature
Project description:ImportanceVentricular septal rupture (VSR) is a rare but life-threatening mechanical complication of acute myocardial infarction associated with high mortality despite prompt treatment. Surgery represents the standard of care; however, only small single-center series or national registries are usually available in literature, whereas international multicenter investigations have been poorly carried out, therefore limiting the evidence on this topic.ObjectivesTo assess the clinical characteristics and early outcomes for patients who received surgery for postinfarction VSR and to identify factors independently associated with mortality.Design, setting, and participantsThe Mechanical Complications of Acute Myocardial Infarction: an International Multicenter Cohort (CAUTION) Study is a retrospective multicenter international cohort study that includes patients who were treated surgically for mechanical complications of acute myocardial infarction. The study was conducted from January 2001 to December 2019 at 26 different centers worldwide among 475 consecutive patients who underwent surgery for postinfarction VSR.ExposuresSurgical treatment of postinfarction VSR, independent of the technique, alone or combined with other procedures (eg, coronary artery bypass grafting).Main outcomes and measuresThe primary outcome was early mortality; secondary outcomes were postoperative complications.ResultsOf the 475 patients included in the study, 290 (61.1%) were men, with a mean (SD) age of 68.5 (10.1) years. Cardiogenic shock was present in 213 patients (44.8%). Emergent or salvage surgery was performed in 212 cases (44.6%). The early mortality rate was 40.4% (192 patients), and it did not improve during the nearly 20 years considered for the study (median [IQR] yearly mortality, 41.7% [32.6%-50.0%]). Low cardiac output syndrome and multiorgan failure were the most common causes of death (low cardiac output syndrome, 70 [36.5%]; multiorgan failure, 53 [27.6%]). Recurrent VSR occurred in 59 participants (12.4%) but was not associated with mortality. Cardiogenic shock (survived: 95 [33.6%]; died, 118 [61.5%]; P < .001) and early surgery (time to surgery ≥7 days, survived: 105 [57.4%]; died, 47 [35.1%]; P < .001) were associated with lower survival. At multivariate analysis, older age (odds ratio [OR], 1.05; 95% CI, 1.02-1.08; P = .001), preoperative cardiac arrest (OR, 2.71; 95% CI, 1.18-6.27; P = .02) and percutaneous revascularization (OR, 1.63; 95% CI, 1.003-2.65; P = .048), and postoperative need for intra-aortic balloon pump (OR, 2.98; 95% CI, 1.46-6.09; P = .003) and extracorporeal membrane oxygenation (OR, 3.19; 95% CI, 1.30-7.38; P = .01) were independently associated with mortality.Conclusions and relevanceIn this study, surgical repair of postinfarction VSR was associated with a high risk of early mortality; this risk has remained unchanged during the last 2 decades. Delayed surgery seemed associated with better survival. Age, preoperative cardiac arrest and percutaneous revascularization, and postoperative need for intra-aortic balloon pump and extracorporeal membrane oxygenation were independently associated with early mortality. Further prospective studies addressing preoperative and perioperative patient management are warranted to hopefully improve the currently suboptimal outcome.
| S-EPMC8529403 | biostudies-literature
Project description: Not available
| S-EPMC2886548 | biostudies-literature
Project description: Not available
| S-EPMC11604528 | biostudies-literature
Project description:Ventricular septal rupture is an extremely rare sequelae of blunt chest trauma, and is mostly diagnosed postmortem. We present a case of a large isolated traumatic ventricular septal rupture after a suicide attempt by jumping from a height of 5 stories, which was successfully treated with surgical closure. (Level of Difficulty: Intermediate.).
| S-EPMC8511473 | biostudies-literature
Project description: Not available
| S-EPMC11776026 | biostudies-literature
Project description:AimsThe long-term survival of patients with isolated congenital ventricular septal defect (VSD) is not well described. The aim of this study was to describe the survival of a national cohort of patients with VSD compared with the general population.Methods and resultsUsing Danish nationwide medical registries, all patients diagnosed with congenital VSD (n = 9,136) in the period 1977-2018 were included. Patients with chromosomal abnormalities and concomitant congenital cardiac malformations other than atrial septal defect were excluded. Each patient was matched by birthyear and sex with ten controls from the general Danish population. Kaplan-Meier survival function and Cox proportional hazard regression were used to compute survival and mortality risk. Median follow-up was 22 years (interquartile range: 11-37). VSD patients displayed lower survival (P<0.001) yielding a hazard ratio (HR) for mortality of 2.7 [95% confidence interval (CI): 2.4-3.0] compared with matched controls. The adjusted HR for mortality among patients with unrepaired VSD was 2.7 (95% CI: 2.4-3.0) and 2.8 (95% CI: 2.1-3.7) for patients with surgically closed VSD. Stratified by era of VSD diagnosis, the HR for mortality was 3.2 (95% CI: 2.8-3.7) for unrepaired patients diagnosed before 1990 and 2.4 (95% CI: 2.0-2.7) for patients diagnosed later. Cardiac-related death was the commonest cause of death among unrepaired (30%) and surgically closed (65%) patients.ConclusionPatients with VSD had lower survival compared with the general population. The HR for mortality was increased over 2.5-fold in patients with unrepaired defect (Eisenmenger syndrome excluded) and over 1.5-fold in patients with surgically closed defect (excluding surgical mortality).
| S-EPMC9805405 | biostudies-literature
Project description:BackgroundPostinfarction ventricular septal rupture (VSR) is an uncommon but challenging mechanical complication for surgeons. This study analyzed the impacts of rupture size on surgical outcomes in patients with VSR.MethodsDuring a 15-year period, from January 2006 to December 2020, 112 patients underwent repairs of postinfarction VSR. Patient clinical data, including angiographic and echocardiographic findings, operative procedures, early morbidity and mortality, and survival time were collated. Univariable and multivariable analyses were performed to identify the risk factors of 30-day mortality.ResultsThe 30-day mortality rate was 7.1% for the whole cohort. The mean survival time estimate was 147.2 months [95% confidence interval (CI): 135.6 to 158.9 months], with a 3-year survival rate of 91.2% and a 5-year survival rate of 89.0%. Multivariable analysis revealed that rupture enlargement rate is an independent risk factor of 30-day mortality. The receiver operating characteristic (ROC) curve indicated that the rupture enlargement rate could predicted the 30-day mortality with high accuracy.ConclusionsDelayed surgery may be considered for patients who respond well to aggressive treatment. The rupture enlargement rate is an independent risk factor for postoperative 30-day morality in patients with delayed VSR repair. Furthermore, the rupture enlargement rate has good predictive value for the prognosis of VSR patients.
| S-EPMC8756216 | biostudies-literature
Project description: Not available
| S-EPMC9536656 | biostudies-literature