ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Surgery
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1590588
Post-infarction ventricular septal defect repair: cardioplegic arrest versus on-pump beating-heart strategy -ten years of experience
Provisionally accepted
- German Heart Center Berlin, Berlin, Germany
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Background: Post-infarction ventricular septal defect (VSD) repair is in general performed on a cardioplegic heart. An alternative concept is VSD repair on a beating heart. Aim of the study was to identify possible differences in survival between the two strategies. Methods: The study was a retrospective, observational, single-centre cohort study of data from all patients who underwent post-infarction VSD repair at our institution between May 2012 and December 2022. VSD repair was performed either on an arrested heart with aortic cross-clamping (n=28 [conventional subgroup]) or on a beating-heart (n=18 [beating-heart subgroup]) using CPB without aortic cross-clamping. Primary end-point was survival at 1 year after surgery. Secondary endpoints included the analysis of perioperative variables, 30-day mortality and long-term survival. Results: Forty six consecutive patients underwent repair of post-infarction VSD (28 in the “conventional subgroup” and 18 in the “beating-heart subgroup”). The mean age of the patients was 66.4±11.2 years and 63% were men. All-cause mortality during the first postoperative 30-days occurred in 12 of 28 patients (43%) in the “conventional subgroup” and in 4 of 18 patients (22%) in the “beating-heart subgroup”). Survival at one and five years was 34% and 27%, respectively for the “conventional subgroup” and 72% and 61% for the “beating-heart subgroup” (hazard ratio, 2.3; 95% confidence interval [CI], 1.1 to 4.8; P=0.0364). Conclusions: The modified surgical approach performing VSD-repair on a beating heart was associated with a lower risk of postoperative death than the conventional surgical strategy.
Keywords: acute myocardial infarction, Post-infarction ventricular septal defect, PI-VSD, VSD, beating-heart surgery
Received: 09 Mar 2025; Accepted: 14 Aug 2025.
Copyright: © 2025 Kaemmel, Pitts, Wert and Pasic. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Julius Kaemmel, German Heart Center Berlin, Berlin, Germany
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