HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dalrymple-Hay, M.J.R. Articles by Monro, J.L. Search for Related Content PubMed PubMed Citation Articles by Dalrymple-Hay, M.J.R. Articles by Monro, J.L.

Eur J Cardiothorac Surg 1998;13:286-292
© 1998 Elsevier Science NL

Should coronary artery bypass grafting be performed at the same time as repair of a post-infarct ventricular septal defect?¹

Wessex Cardiothoracic Centre, Southampton General Hospital, Tremona Road, Southampton S016 6YD, UK

Received 29 September 1997; received in revised form 2 January 1998; accepted 14 January 1998.

Corresponding author. Tel.: +44 1703 796124; fax: +44 1703 796614.

Objective: The value of coronary artery bypass grafting (CABG) at the time of repair of a post-infarct ventricular septal defect (VSD) remains controversial. The aim of this study was to analyse the effect of CABG on early mortality and survival following repair of an acquired VSD. Methods: Over 23 years, 179 patients, 118 male, 61 female, mean age 66 years (range 43–80), have undergone repair of a post-related VSD in our unit. A total of 29 patients, who predominantly form the earlier part of the series, were operated on greater than 1 month after the infarct and are, therefore, excluded. Coronary angiography was performed in 98 (65.3%) of the remaining 150 patients. Of these, 41 had coronary artery disease (CAD) limited to the infarct-related vessel and 57 had additional significant CAD. Those with CAD limited to the infarct-related vessel were not grafted (Group A). Of those, 40 with significant CAD underwent CABG at the time of VSD repair (Group B) and 17 did not (Group C). In 52 patients the coronary anatomy was not documented (Group D). Risk factors for early mortality were evaluated using logistic regression. Actuarial survival was compared using log rank and Wilcoxon tests. Cox’s proportional hazards method was used to determine factors affecting survival. Results: Overall, 30 day mortality was 32%. CABG did not significantly decrease operative mortality (logistic regression). There was no statistically significant difference in early mortality or actuarial survival between the four groups. CABG was not associated with an increased survival (Cox’s method). Conclusions: Concomitant CABG at the time of VSD repair does not affect early mortality nor confer survival benefits. There seems to be no demonstrable benefit in revascularisation at the time of repair and, therefore, it may be unnecessary to perform CABG or coronary angiography in these patients.

Key Words: Ventricular septal defect • Coronary artery bypass grafting • Survival

This article has been cited by other articles:

				S. Perrotta and S. Lentini In patients undergoing surgical repair of post-infarction ventricular septal defect, does concomitant revascularization improve prognosis? Interactive CardioVascular and Thoracic Surgery, November 1, 2009; 9(5): 879 - 887. [Abstract] [Full Text] [PDF]

				R. Lundblad, M. Abdelnoor, O. R. Geiran, and J. L. Svennevig Surgical repair of postinfarction ventricular septal rupture: Risk factors of early and late death J. Thorac. Cardiovasc. Surg., April 1, 2009; 137(4): 862 - 868. [Abstract] [Full Text] [PDF]

				A. Jeppsson and P. Johnsson Reply to Ramnarine and Grayson Eur. J. Cardiothorac. Surg., July 1, 2005; 28(1): 186 - 187. [Full Text] [PDF]