Transcatheter closure of post-myocardial infarction ventricular septal rupture

Gabriele Egidy Assenza, Doff B. McElhinney, Anne Marie Valente, Disty D. Pearson, Massimo Volpe, Giuseppe Martucci, Michael J. Landzberg, James E. Lock

Research output: Contribution to journalArticle

Abstract

Background-Ventricular septal rupture (VSR) after acute myocardial infarction (AMI) is a potentially lethal mechanical complication of acute coronary syndromes. Given high surgical mortality, transcatheter closure has emerged as a potential strategy in selected cases. We report our single-center experience with double-umbrella device percutaneous closure of post-AMI VSR. Methods and Results-In this single-center, retrospective, cohort study, patients who underwent transcatheter closure of post-AMI VSR between 1988 and 2008 at Boston Children's Hospital were included. Data were analysed according to whether the patients underwent direct percutaneous VSR closure or closure of a residual VSR after a previous surgical approach. Primary outcome was mortality rate at 30 days. Clinical predictors of primary outcome were investigated using univariate logistic regression. Thirty patients were included in the study (mean age, 67±8 years). A total of 40 closure devices were implanted. Major periprocedural complications occurred in 4 (13%) patients. Cardiogenic shock, increasing pulmonary/systemic flow ratio, and the use of the new generation (6-arm) STARFlex device all were associated with higher risk of mortality. The Model for End-Stage Liver Disease Excluding international normalized ratio (MELD-XI) score at the time of VSR closure seemed to be most strongly associated with death (odds ratio, 1.6; confidence interval, 1.1-2.2; P

Original languageEnglish
Pages (from-to)59-67
Number of pages9
JournalCirculation: Cardiovascular Interventions
Volume6
Issue number1
DOIs
Publication statusPublished - Feb 2013

Keywords

  • Catheterization
  • Interventional closure
  • Myocardial infarction
  • Ventricular septal defect

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Assenza, G. E., McElhinney, D. B., Valente, A. M., Pearson, D. D., Volpe, M., Martucci, G., Landzberg, M. J., & Lock, J. E. (2013). Transcatheter closure of post-myocardial infarction ventricular septal rupture. Circulation: Cardiovascular Interventions, 6(1), 59-67. https://doi.org/10.1161/CIRCINTERVENTIONS.112.972711