Delayed surgical VSR repair still yields favourable survival outcomes

In patients with ventricular septal rupture (VSR) complicated by cardiogenic shock, deferred surgical repair, performed >10 days after diagnosis, seems to yield favourable survival benefits, a recent study has found. The concurrent use of mechanical circulatory support (MCS), while apparently safe, has only limited clinical impact.

Researchers enrolled 27 patients (mean age 64.96±8.69 years, 74.1 percent men) who underwent deferred VSR repair while stabilized on MCS. The primary outcome was all-cause mortality; other end-points included interventions applied and complications.

Nine patients died during follow-up. Nonsurvivors were more likely to have three-vessel disease (p=0.001) and lower mean arterial pressure (p=0.007); otherwise, survivors and nonsurvivors were comparable in terms of sociodemographic and clinical characteristics. The mean time to VSR repair was 18.85 days.

Logistic regression analysis found that delayed revascularization was significantly correlated with worse survival (odds ratio [OR], 17.500, 95 percent confidence interval [CI], 2.365–129.506; p=0.005), while early surgery led to better outcomes (OR, 0.835, 95 percent CI, 16.163–21.541; p=0.041). Other significant predictors were ejection fraction, the presence of three-vessel disease, and prolonged ionotropic support.

Though statistically comparable between groups, survivors tended to receive shorter postoperative MCS than comparators who died. The findings suggest that “the key to better survival seems to be haemodynamic stabilization rather than MCS,” the researchers said. “This requires further investigation, specifically the optimal duration of support.”