Re-repair of post–myocardial infarction ventricular septal rupture

Background

Survivors of post–myocardial infarction (MI) ventricular septal rupture (VSR) repair may require reintervention if initial repairs are incomplete or fail. We assessed patients undergoing post-MI VSR re-repair.

Methods

Between January 1976 and July 2023, 38 consecutive patients underwent re-repair of post-MI VSR at Cleveland Clinic. Preoperative characteristics, operative details, and postoperative outcomes were obtained through medical records review, and patients were followed for survival.

Results

Thirty-two (84%) re-repairs were elective/urgent, and 6 (16%) were emergencies. Preoperative temporary mechanical circulatory support was used in 14 (37%), with 12 isolated intra-aortic balloon pumps. Indications for re-repair were recurrent VSR detected during postoperative surveillance (n = 25; 66%) and residual VSR after incomplete initial repair (n = 13; 34%). The median time from initial repair to re-repair was 55 days (15th/85th percentiles: 5-331 days). Two patients (5.3%) had residual or recurrent VSR after re-repair but received no intervention due to hemodynamic insignificance. Postoperative complications included sepsis (n = 7; 18%), stroke (n = 6; 16%), and new-onset dialysis (n = 6; 16%). Operative mortality was 32% (n = 12), with differences between patients who underwent surgery before January 2001 (n = 10/18; 56%) and those who did so after January 2001 (n = 2/20; 10%), as well as between patients who received preoperative temporary mechanical circulatory support (n = 8/14; 57%) and those who did not (n = 4/24; 17%).

Conclusions

Patients with failed or incomplete initial post-MI VSR repairs may be considered for re-repair, as modern-day improvements in perioperative care may be associated with more favorable outcomes. Referral to an expert tertiary center should be considered owing to the surgical complexity of re-repair.