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Calvert, Patrick A.; Cockburn, James; Wynne, Dylan; Ludman, Peter; Rana, Bushra S.; Northridge, David; Mullen, Michael J.; Malik, Iqbal; Turner, Mark; Khogali, Saib; Veldtman, Gruschen R.; Been, Martin; Butler, Rob; Thomson, John; Byrne, Jonathan; MacCarthy, Philip; Morrison, Lindsay; Shapiro, Len M.; Bridgewater, Ben; de Giovanni, Jo; Hildick-Smith, David

Percutaneous Closure of Postinfarction Ventricular Septal Defect : In-Hospital Outcomes and Long-Term Follow-Up of UK Experience

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  • Medientyp: E-Artikel
  • Titel: Percutaneous Closure of Postinfarction Ventricular Septal Defect : In-Hospital Outcomes and Long-Term Follow-Up of UK Experience : In-Hospital Outcomes and Long-Term Follow-Up of UK Experience
  • Beteiligte: Calvert, Patrick A.; Cockburn, James; Wynne, Dylan; Ludman, Peter; Rana, Bushra S.; Northridge, David; Mullen, Michael J.; Malik, Iqbal; Turner, Mark; Khogali, Saib; Veldtman, Gruschen R.; Been, Martin; Butler, Rob; Thomson, John; Byrne, Jonathan; MacCarthy, Philip; Morrison, Lindsay; Shapiro, Len M.; Bridgewater, Ben; de Giovanni, Jo; Hildick-Smith, David
  • Erschienen: Ovid Technologies (Wolters Kluwer Health), 2014
  • Erschienen in: Circulation, 129 (2014) 23, Seite 2395-2402
  • Sprache: Englisch
  • DOI: 10.1161/circulationaha.113.005839
  • ISSN: 0009-7322; 1524-4539
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: Background— Postinfarction ventricular septal defect carries a grim prognosis. Surgical repair offers reasonable outcomes in patients who survive a healing phase. Percutaneous device implantation represents a potentially attractive early alternative. Methods and Results— Postinfarction ventricular septal defect closure was attempted in 53 patients from 11 centers (1997–2012; aged 72±11 years; 42% female). Nineteen percent had previous surgical closure. Myocardial infarction was anterior (66%) or inferior (34%). Time from myocardial infarction to closure procedure was 13 (first and third quartiles, 5–54) days. Devices were successfully implanted in 89% of patients. Major immediate complications included procedural death (3.8%) and emergency cardiac surgery (7.5%). Immediate shunt reduction was graded as complete (23%), partial (62%), or none (15%). Median length of stay after the procedure was 5.0 (2.0–9.0) days. Fifty-eight percent survived to discharge and were followed up for 395 (63–1522) days, during which time 4 additional patients died (7.5%). Factors associated with death after postinfarction ventricular septal defect closure included the following: age (hazard ratio [HR]=1.04; P =0.039), female sex (HR=2.33; P =0.043), New York Heart Association class IV (HR=4.42; P =0.002), cardiogenic shock (HR=3.75; P =0.003), creatinine (HR=1.007; P =0.003), defect size (HR=1.09; P =0.026), inotropes (HR=4.18; P =0.005), and absence of revascularization therapy for presenting myocardial infarction (HR=3.28; P =0.009). Prior surgical closure (HR=0.12; P =0.040) and immediate shunt reduction (HR=0.49; P =0.037) were associated with survival. Conclusions— Percutaneous closure of postinfarction ventricular septal defect is a reasonably effective treatment for these extremely high-risk patients. Mortality remains high, but patients who survive to discharge do well in the longer term.
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