Surgical outcomes and long-term survival after repair of post-myocardial infarction ventricular septal defect: a 30-year single-center experience.
- 1Department of Thoracic and Cardiovascular Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Abstract
Post-myocardial infarction ventricular septal defect (pMI-VSD) remains a catastrophic mechanical complication of acute myocardial infarction despite advances in surgical management. We evaluated early and long-term outcomes after surgical repair of pMI-VSD at a tertiary referral center. We retrospectively reviewed 80 consecutive patients who underwent surgical repair of pMI-VSD between January 1995 and November 2025. Early outcomes, postoperative complications including residual shunting, and long-term all-cause mortality were analyzed. Long-term survival was estimated using the Kaplan-Meier method, and a parsimonious Cox proportional hazards model was used to identify factors associated with all-cause mortality. The mean age was 70.4±9.1 years, and 47.5% were male. The 30-day mortality rate was 7.5%. Residual shunts were detected in 35 patients (43.8%), of whom five (6.3% of the overall cohort) underwent reoperation. During a median observed follow-up of 58.5 months, 38 patients (47.5%) died. Estimated survival was 81.0% [95% confidence interval (CI): 72.8-90.1%] at 1 year, 70.5% (95% CI: 60.8-81.8%) at 5 years. In multivariable analysis, age and pre-existing chronic kidney disease (CKD) were associated with all-cause mortality. Survival differed between patients operated on in ≤2015 and >2015 (log-rank P=0.03), although this unadjusted comparison may reflect concurrent changes in patient characteristics and management. Favorable early and long-term outcomes were observed among selected patients who underwent surgical repair of pMI-VSD at an experienced center. Residual shunt status was not associated with a statistically detectable difference in long-term survival, although quantitative hemodynamic assessment was not uniformly available. Survival was better in the more recent era, although the contributions of changes in patient selection, surgical technique, and perioperative management cannot be distinguished in this observational cohort. However, this finding should be interpreted cautiously given the observational nature of the study.
Related
- From cardiogenic shock to surgical success: Addressing ventricular septal rupture in a myocardial infarction case
- Outcomes of Surgical Versus Transcatheter Mitral Valve Repair or Replacement in Patients With Myocardial Infarction and Concomitant Mitral Regurgitation: A Retrospective Analysis of Real-World Data
- ECG-Derived Synthetic Left Ventricular Mechanics Predict Mortality After Acute Myocardial Infarction and Fatal Myocardial Infarction in the General Population
- Impact of hypertriglyceridemia on right ventricular deformation in patients with left ventricular myocardial infarction: a cardiac magnetic resonance imaging study
- Factors associated with 30-day mortality in patients with post-myocardial infarction ventricular septal rupture: a retrospective cohort study
BibTeX
@article{lee2026surgical,
title = {{Surgical outcomes and long-term survival after repair of post-myocardial infarction ventricular septal defect: a 30-year single-center experience.}},
author = {Yoonseo Lee and Wook Sung Kim},
journal = {Journal of thoracic disease},
year = {2026},
month = sep,
doi = {10.21037/jtd-2026-2033},
url = {https://europepmc.org/article/MED/42996930},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Surgical outcomes and long-term survival after repair of post-myocardial infarction ventricular septal defect: a 30-year single-center experience.
AU - Yoonseo Lee
AU - Wook Sung Kim
PY - 2026
DA - 2026/09/29
JO - Journal of thoracic disease
DO - 10.21037/jtd-2026-2033
UR - https://europepmc.org/article/MED/42996930
AB - Post-myocardial infarction ventricular septal defect (pMI-VSD) remains a catastrophic mechanical complication of acute myocardial infarction despite advances in surgical management. We evaluated early and long-term outcomes after surgical repair of pMI-VSD at a tertiary referral center. We retrospectively reviewed 80 consecutive patients who underwent surgical repair of pMI-VSD between January 1995 and November 2025. Early outcomes, postoperative complications including residual shunting, and long-term all-cause mortality were analyzed. Long-term survival was estimated using the Kaplan-Meier method, and a parsimonious Cox proportional hazards model was used to identify factors associated with all-cause mortality. The mean age was 70.4±9.1 years, and 47.5% were male. The 30-day mortality rate was 7.5%. Residual shunts were detected in 35 patients (43.8%), of whom five (6.3% of the overall cohort) underwent reoperation. During a median observed follow-up of 58.5 months, 38 patients (47.5%) died. Estimated survival was 81.0% [95% confidence interval (CI): 72.8-90.1%] at 1 year, 70.5% (95% CI: 60.8-81.8%) at 5 years. In multivariable analysis, age and pre-existing chronic kidney disease (CKD) were associated with all-cause mortality. Survival differed between patients operated on in ≤2015 and >2015 (log-rank P=0.03), although this unadjusted comparison may reflect concurrent changes in patient characteristics and management. Favorable early and long-term outcomes were observed among selected patients who underwent surgical repair of pMI-VSD at an experienced center. Residual shunt status was not associated with a statistically detectable difference in long-term survival, although quantitative hemodynamic assessment was not uniformly available. Survival was better in the more recent era, although the contributions of changes in patient selection, surgical technique, and perioperative management cannot be distinguished in this observational cohort. However, this finding should be interpreted cautiously given the observational nature of the study.
SN - 2072-1439
SN - 2077-6624
ER -