Percutaneous Closure of Post‐Infarction Ventricular Septal Defects—An Over Decade‐long Experience. (11th January 2017)

• Record Type: Journal Article
• Authors: Sabiniewicz, Robert; Huczek, Zenon; Zbroński, Karol; Scisło, Piotr; Rymuza, Bartosz; Kochman, Janusz; Marć, Miłosz; Grygier, Marek; Araszkiewicz, Aleksander; Dziarmaga, Mieczysław; Leśniewicz, Piotr; Hiczkiewicz, Jarosław; Kidawa, Michał; Filipiak, Krzysztof J.; Opolski, Grzegorz
• Is Part Of: Journal of interventional cardiology. Volume 30:Number 1(2017:Feb.)
• Page Start: 63
• Page End: 71
• Publication Date: 2017-01-11
• Subjects: Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.1206
• DOI: 10.1111/joic.12367
• Languages: English
• ISSNs: 0896-4327

Abstract

Abstract : Objectives: To report an over decade‐long experience with percutaneous post‐infarction ventricular septal defect (PIVSD) closure. Background: PIVSDs remains a major clinical challenge with extremely high mortality. Data concerning interventional closure of PIVSD is scarce. Methods: All percutaneous PIVSD closures performed between 2003 and 2016 in 8 participating centres were identified. Data concerning patients and procedures was acquired. Patients were divided into two groups, based on the time interval between VSD diagnosis and closure (≤14 days—acute phase, >14 days—non‐acute phase). Results: Twenty‐one percutaneous PIVSD closures were performed on 20 patients (9 females, mean age: 70 years). Mean interval between the diagnosis and the procedure was 182.6 ± 500 days (range: 7–2228). Defects were mostly located in apical (55%) segments of the septum. In 7 cases (33%) the procedure was performed in the acute phase. The closure was technically successful in 17 cases (81%). Four patients died within 48 hours after the procedure. 30‐days survival rate of the entire cohort was 70%. Univariate analysis revealed impact of technical success of the procedure (HR 0.13, CI 0.03–0.68 P = 0.016) and white blood cell count (HR 1.36 per unit increase, CI 1.1–1.69, P = 0.005) on 30‐day mortality. Conclusions: In a selected population of patients percutaneous PIVSD closure is feasible and provides satisfactory survival rate. Procedural success has a protective impact on survival. Timing of the closure remains controversial. Procedure in the non‐acute phase carries lower mortality, but at the same time introduces a selection bias. Larger registry‐based studies are required.