Early and mid-term outcomes after surgical repair of post-infarction ventricular septal rupture from the Netherlands Heart Registration: a nationwide analysis

Ventricular septal rupture (VSR) is a rare, life-threatening complication of acute myocardial infarction. Large cohort data from multicentre studies are scarce and only recent evidence is accumulating about the current short- and long-term results of this condition. The early and mid-term outcomes after surgical VSR repair were analysed from the Netherlands Heart Registration database.

All adults who underwent surgical VSR repair in the Netherlands from 1 January 2014 to 31 December 2019 were included. The primary outcomes were in-hospital and mid-term mortality. Secondary outcomes included post-operative complications, and predictors of early and overall mortality.

Overall, 227 consecutive patients [68.7% males, median age 67.0 (59.0–74.0) years] underwent VSR repair in the 6-year period. Critical pre-operative status was present in 66.5% of patients and emergent/salvage surgery was required in 60.4% of subjects. In-hospital mortality was 39.2%. Post-discharge mortality occurred in 16.9% of hospital survivors at a median follow-up of 2.8 [0.9–4.5] years. Independent association with in-hospital mortality was found for older age (P = .001), higher body mass index (P = .021), emergent/salvage surgery (P = .007), higher pre-operative serum creatinine (P = .007), and intra-operative extracorporeal membrane oxygenation (P = .049). Independent association with overall mortality included older age (P = .003), emergent/salvage surgery (P = .002), and higher pre-operative creatinine (P = .002), while pre-operative left ventricular ejection fraction >50% was independently associated with better survival (P = .019). Logistic EuroSCORE I predicted in-hospital mortality more reliably than EuroSCORE II.

Surgical VSR repair remains associated with frequent severe peri-operative complications and remarkable in-hospital mortality. However, mid-term follow-up for patients discharged from hospital shows excellent 5-year survival.