| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Eur J Cardiothorac Surg 2003;24:940-946
© 2003 Elsevier Science NL
a Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Manchester, UK
b Department of Cardiothoracic Surgery, The Cardiothoracic Centre-Liverpool, Thomas Drive, Liverpool, L14 3PE, UK
c Department of Clinical Governance, The Cardiothoracic Centre-Liverpool, Thomas Drive, Liverpool, L14 3PE, UK
d Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool, UK
e Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester, UK
Received 1 May 2003; received in revised form 17 July 2003; accepted 18 July 2003.
* Corresponding author. The Cardiothoracic Centre-Liverpool, Thomas Drive, Liverpool, L14 3PE, UK. Tel.: +44-151-293-2336; fax: +44-151-288-2371
e-mail: tony.grayson{at}ctc.nhs.uk
Objective: To present the 5-year experience of the northwest of England's surgical repair of post myocardial infarction (MI) ventricular septal defects (VSD). Our primary aim was to evaluate the effect of concomitant coronary artery bypass grafting (CABG) on mid-term survival and also to identify prognostic indicators. Methods: A multi-centre regional observational study involving clinical data from 65 consecutive patients who underwent post MI VSD repair in the northwest of England between April 1997 and March 2002. Both prospective and retrospective collection of preoperative, operative and postoperative information was performed. Patient follow-up was performed by linking their records to the National Strategic Tracing Service database. Multivariate logistic regression and Cox proportional hazards analyses were used to identify independent risk factors for poor prognosis. Results: Of the 65 patients included in the study, 42 (64.6%) underwent concomitant CABG with a median of two grafts. The majority of patients who had their coronary arteries grafted had multivessel disease (92.9%). Overall 30-day mortality was 23.1%. Predictors of poor prognosis included preoperative inotropes (P<0.001) and total occlusion of infarct related artery (P=0.03). The crude hazard ratio (HR) of mid-term mortality for concomitant CABG patients was 0.82 [95% confidence interval (CI) 0.38–1.78; P=0.62]. After adjustment for differences in patient and disease characteristics, the adjusted HR of mid-term mortality for concomitant CABG patients was 0.17 (95% CI 0.04–0.74; P=0.019). The adjusted freedom from death in the concomitant CABG patients at 30 days, 1, 2, and 4 years was 96.2%, 91.6%, 88.8%, and 82.8%, respectively, compared with 79.1%, 58.8%, 49.1%, and 32.2% for the non-concomitant CABG patients. Conclusion: These data provide evidence that concomitant CABG is significantly beneficial to mid-term mortality rates. We recommend that patients who present with post MI VSD who have multivessel disease should be routinely revascularised.
Key Words: Myocardial infarction • Ventricular septal defect • Coronary artery bypass grafting • Mid-term survival • Risk adjustment
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. K. Agnihotri, J. C. Madsen, and W. M. Daggett Jr Surgical Treatment of Complications of Acute Myocardial Infarction: Postinfarction Ventricular Septal Defect and Free Wall Rupture Card. Surg. Adult, January 1, 2008; 3(2008): 753 - 784. [Full Text]
|
|
|
|
 |
|
 A. Jeppsson and P. Johnsson Reply to Ramnarine and Grayson Eur. J. Cardiothorac. Surg., July 1, 2005; 28(1): 186 - 187. [Full Text] [PDF]
|
|
|
|
|
|
I. R. Ramnarine and A. D. Grayson Simultaneous repair of post-infarct ventricular septal defect and coronary artery bypass grafting Eur. J. Cardiothorac. Surg., July 1, 2005; 28(1): 185 - 186. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Deville, L. Labrousse, E. Choukroun, and F. Madonna Surgery for post-infarction ventricular septal defect (VSD): double patch and glue technique for early repair MMCTS, April 25, 2005; 2005(0425): 562. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Jeppsson, H. Liden, P. Johnsson, M. Hartford, and K. Radegran Surgical repair of post infarction ventricular septal defects: a national experience Eur. J. Cardiothorac. Surg., February 1, 2005; 27(2): 216 - 221. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
