Registro multicéntrico de comunicación interventricular postinfarto agudo de miocardiocambios en el manejo y pronóstico durante la última década

Abstract

Postinfarction ventricular septal defect is a rare mechanical complication of acute myocardial infarction, whose mortality remains very high. Despite advances in medical treatment, there are little changes in the mortality rates, reaching more than 60% depending on the source consulted and seems to have shown little improvement over the last two decades. The surgical treatment to repair the defect created in the interventricular septum is the most important treatment. However, it is not clear when is the optimal timing for surgery, because the mortality for operating at the acute moment of diagnosis is very high. The objective of our research was to study what has been the evolution of postinfarction ventricular septal defect in our country in the last decade. We tried to analyze the evolution of survival in this time, and which treatment and management factors may be involved in an improvement in the prognosis. Furthermore, we analyzed what was the result of the patients with surgical repair and the role of mechanical circulatory support in this pathology. A retrospective, multicenter study was carried out, recruiting a total of 13 tertiary hospitals that contributed a total of 141 patients with this complication between January 2008 and December 2018. The overall mortality of the study in this period remained very high, with 65% of deaths at 1 year of follow-up. However, we observed a significant trend towards lower mortality in the second half of the study. The main determinant and differential factor in treatment was the use of ECMO as mechanical circulatory support. In addition, in this second half, heart transplantation was also chosen to a greater extent as a definitive treatment. In patients who are candidates for surgery, we have observed a window of lower mortality from day 4 of the diagnosis of ventricular septal defect, with rates below 30%. In this context, mechanical circulatory support also seems essential to keep the patient hemodynamically stable until the intervention.