Medical therapy

Surgical and percutaneous options for post-infarction VSD improve survival compared to medical treatment

September 18, 2022

2 minute read

Source/Disclosures

Source:

Giblett J, et al. Late-breaking science in structural heart disease: session II, in collaboration with The European Journal of the Heart/Eurointervention. Presented at: TCT Scientific Symposium; September 16-19, 2022; Boston (hybrid meeting).

Disclosures:
Giblett does not report any relevant financial information.


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BOSTON — In patients with post-infarction ventricular septal malformations, percutaneous and surgical treatments reduced mortality rates compared to historical medical treatment data, researchers reported at TCT 2022.

Percutaneous and surgical post-infarction ventricular septal defect (VSD) strategies did not differ significantly from each other in all-cause mortality at 5 years, but the in-hospital mortality rate was higher with the percutaneous approach, Joel Giblettdoctor, consultant interventional cardiologist at Liverpool Heart and Chest Hospital, Liverpool, UK, told a news conference.

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“Post-infarction VSD is a relatively rare complication of acute myocardial infarction that occurs in about 1 in 500 cases,” Giblett said at the press conference. “Essentially, this is a tear between the right and left ventricles that causes a large-territory double-infarct infarction combined with exposure of the right ventricle to systemic pressures.”

In patients with post-infarction VSD treated with medical therapy, the 1-month mortality rate is greater than 94%, Giblett said.

He said mortality rates after surgery for post-infarction VSD are high, but not as high as those associated with medical treatment, and so far little is known about outcomes after percutaneous treatment for VSD. post-infarction.

In a retrospective observational study, Giblett and colleagues analyzed 362 patients with post-infarction VSD from the UK National Registry who were treated with either an initial surgical repair strategy (n=230) or an initial percutaneous repair strategy (n= 131) between 2010 and 2021.

The primary endpoint of all-cause mortality at 5 years did not differ significantly between the groups (log-rank P = 0.059), and both groups had much lower mortality rates compared to historical data for patients treated with medical therapy, Giblett said at the press conference.

The percutaneous group had a higher hospital mortality rate than the surgical group (55% versus 44.2%; P = 0.048), but this result may have been influenced by selection bias, he said.

“Many of the percutaneous patients in this analysis could not undergo surgical repair,” Giblett said at the press conference. “They would have been turned down for that.”

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In a historical analysis of hospital discharge at 5 years, mortality rates were similar between the groups (log-rank P = 0.646), he said.

In a multivariate analysis, percutaneous treatment was associated with 5-year mortality (adjusted RR = 1.44; 95% CI, 1.01-2.05; P = 0.042), as did the shorter time between acute MI and VSD repair, creatinine level, multivascular CAD and cardiogenic shock, Giblett said at the press conference, noting that right ventricular dysfunction, traditionally a metric used to identify patients with post-infarction VSD who should not be treated invasively, was not independently associated with mortality.

“Delaying treatment appears to reduce mortality,” he said.

The registry is more than double the size of any previous series in this population, and now “we really need to move into prospective studies,” Giblett said at the press conference.

He said that in the last year of the study period, there were fewer patients treated surgically or percutaneously due to the impact of the COVID-19 pandemic. “I don’t know if it was because there were fewer presentations or if it was because [hospitals] during the pandemic were not prepared to take these patients to the cath lab,” he said.