Percutaneous closure of postinfarction ventricular septal defect: in-hospital outcomes and long-term follow-up of UK experience.
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.
['Calvert|Patrick A|PA|', 'Cockburn|James|J|', 'Wynne|Dylan|D|', 'Ludman|Peter|P|', 'Rana|Bushra S|BS|', 'Northridge|David|D|', 'Mullen|Michael J|MJ|', 'Malik|Iqbal|I|', 'Turner|Mark|M|', 'Khogali|Saib|S|', 'Veldtman|Gruschen R|GR|', 'Been|Martin|M|', 'Butler|Rob|R|', 'Thomson|John|J|', 'Byrne|Jonathan|J|', 'MacCarthy|Philip|P|', 'Morrison|Lindsay|L|', 'Shapiro|Len M|LM|', 'Bridgewater|Ben|B|', 'de Giovanni|Jo|J|', 'Hildick-Smith|David|D|']
D000368:Aged D000369:Aged, 80 and over D006328:Cardiac Catheterization D005260:Female D005500:Follow-Up Studies D006345:Heart Septal Defects, Ventricular D017052:Hospital Mortality D006801:Humans D053208:Kaplan-Meier Estimate D008297:Male D008875:Middle Aged D009203:Myocardial Infarction D011379:Prognosis D012307:Risk Factors D055989:Septal Occluder Device D012770:Shock, Cardiogenic D006113:United Kingdom
ventricular septal defect myocardial infarction death Amplatzer occluder device percutaneous administration