INTRODUCTION
Ventricular septal rupture (VSR) is a
rare but fatal mechanical complication of acute myocardial infarction
(AMI), with associated medical management mortality that ranges from
41% to 80% 1-4. Traditional opinion believed
immediate repair for VSR was necessary because rupture can expand
abruptly, resulting in sudden hemodynamic collapse. The 2013 AHA
guidelines for STEMI concluded that emergency surgical repair is
recommended for all patients with VSR, even in hemodynamically stable
patients5. Although surgery is recognized as the most
effective treatment for VSR, it carries an exceedingly high
postoperative mortality of 42.9~80.5% within 7 days of
VSR onset2,6.
However, due to an unperfect transportation system in middle-income
economies like China, a large proportion of VSR patients were not able
to receive emergency transportation to qualified cardiac surgery
centers. Therefore, unplanned delayed surgery was more common in China,
which differed from the situation in higher-income economies.
On the other hand, delayed surgery has several advantages compared to
immediate surgery. Either the difficulty of procedures or the
postoperative mortality and morbidity all declined significantly in
delayed surgery7. As preoperative mechanical
assistance got popular, delayed surgery was accepted gradually by some
centers8,9. The 2017 ESC guidelines for STEMI suggest
that delayed surgery could be considered for patients who respond well
to aggressive treatment10.
Risk factors for postoperative
30-days mortality including advanced age, female gender, renal
dysfunction, cardiogenic shock, decreased EF,
three-branch lesions, and unstable
status requiring preoperative IABP have been identified in the previous
researches6. Other research found that larger ruptures
are more likely to cause preoperative cardiogenic
shock7, but no direct correlation between rupture size
and postoperative mortality was reported. However, only a few studies
about delayed surgery for VSR were reported, and the majority were case
reports and case series. Previous studies left a gap in risk factors
analysis of delayed surgery for VSR. In this study, we aim to find the
independent risk factors of delayed VSR repair by reviewing the clinical
data of VSR patients in our center and analyze the impact of rupture
size on the critical preoperative status and surgical outcomes.