Surgical Repair of Post Infarction Ventricular Septal Rupture: An 18 Years' Retrospective Multicenter Study- Where there was no ECMO

Background:
Ventricular Septal Rupture (VSR) is a rare but challenging complication after Myocardial Infarction (MI).
Objectives:
The present study aimed to evaluate the surgical outcomes of VSR over 18 years.
Methods:
This multicenter study was conducted on 88 patients with post-MI VSR during 2000 - 2018. 

Results:
A consecutive series of 88 patients with surgical repair of VSR was evaluated. The patients (n = 11) presenting hemodynamic deterioration at the time of hospital admission died before any attempt for surgery. The mean intervals between MI and VSR diagnosis and between admission and operation were 7.5 ± 7.2 and 5 ± 5 days, respectively. VSR location did not influence the outcomes (P = 0.1). Concomitant coronary bypass was done for all patients. Only 25 patients survived and left the hospital (13 patients died in the operating room due to pump weaning failure and 50 patients died in the ICU due to low cardiac output). The predictors of poor prognosis included low ejection fraction (P = 0.01), prolonged pump time (P = 0.01), and operation in the second half of the study period (P = 002). However, the results of multivariate analysis showed that none of them was an independent predictor of perioperative mortality.
Conclusions:
The perioperative mortality rate of VSR has remained high in case of inaccessibility to assist devices. Hence, VSR repair is recommended to be limited to certain centers with adequate experiences.