Surgical repair of post-infarction ventricular septal defect: 19 years of experience.

OBJECTIVES: To review our experience of surgical repair of post-infarction ventricular septal defect (VSD). METHODS: In the period 1983-2002, 50 patients underwent repair of VSD. Mean age was 66 years, male sex 52%. Infarct location was anterior in 60% and posterior in 40% of cases. Median interval between rupture and surgery was 2 days. Preoperative intra-aortic balloon counterpulsation was employed in 56%; a coronary angiogram was performed in 98% of cases. A patch repair technique was used in 90% of cases. Coronary bypass grafting was associated in 50% of patients. RESULTS: Mean aortic clamp time was 101+/-31 min. Global operative mortality was 36%, respectively 26.7% in anterior and 50% in posterior location (p=ns). Emergency operation and interval from rupture to surgery less than 3 days were univariate predictor of early mortality. Five years survival excluding operative deaths was 76%. CONCLUSIONS: The surgical repair of post-infarction VSD entails a high operative mortality; different techniques were employed with similar results. Emergency operation is associated with a worse short-term prognosis; long-term survival is acceptable.