AUTHOR=Treille de Grandsaigne Henri , Bouisset Frédéric , Porterie Jean , Biendel Caroline , Marcheix Bertrand , Lairez Olivier , Labaste François , Elbaz Meyer , Galinier Michel , Delmas Clément 

TITLE=Incidence, management, and prognosis of post-ischaemic ventricular septal defect: Insights from a 12-year tertiary centre experience

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1066308

DOI=10.3389/fcvm.2022.1066308

ISSN=2297-055X

ABSTRACT=Background: Among mechanical complications of acute myocardial infarction, ventricular septal defect (VSD) is uncommon but still serious. The evolution of emergency coronary revascularization paradoxically decreased our knowledge of such disease, making it even rarer. 
Aim: To describe ischemic VSD incidence, management and associated in-hospital and 1-year outcomes during a 12 years period
Method: A retrospective single-centre register of patients managed for ischemic VSD between January 2009 and December 2020. 
Results: Ninety-seven patients were included representing 8 patients/ year and an incidence of 0.44% of ACS managed. Patient were 73 yo male (n= 54, 56%) with STEMI presentation (n= 75, 79%) and already Q necrosis on ECG (n=70, 74%). Forty-nine (51%) patients underwent PCI, 60 (62%) inotrope/vasopressors infusion and 70 (72%) acute mechanical circulatory support (IABP 62%, ECMO 13% and Impella® 3%). VSD surgical repair was performed for 44 (45%) and 1 patient was transplanted. In-hospital mortality was 71%, and 86% at 1 year, without significant improvement over the decade. Surgery appears as a protective factor (0.51 [0.28-0.94] p = 0.003), whereas age (1.06 [1.03-1.09], p < 0.001) and lactate (1.16 [1.09-1.23], p < 0.001) were linked to higher 1-year mortality. None of the patients medically managed survived at 1-year.
Conclusion: Post-ischemic VSD is a rare but serious complication still associated to high mortality. Corrective surgery is associated with a better survival, however, timing, patient selection, place for mechanical circulatory support need to be defined.