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OUTCOMES OF TRANSCATHETER CLOSURE OF POST-MYOCARDIAL INFARCTION VENTRICULAR SEPTAL DEFECT
45 JACC April 5, 2016 Volume 67, Issue 13
ACC.i2 Interventional Cardiology OUTCOMES OF TRANSCATHETER CLOSURE OF POST-MYOCARDIAL INFARCTION VENTRICULAR SEPTAL DEFECT Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 10:00 a.m.-10:45 a.m. Session Title: Acute Myocardial Infarction Abstract Category: 1. ACC.i2 Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology Presentation Number: 1105-118 Authors: Yu Xie, Justin Cox, Abhijeet Dhoble, Abhimanyu (Manu) Uberoi, Rahul Sharma, Tarun Chakravarty, William Collins, Raj Makkar, Fardad Esmailian, Prediman Shah, Bojan Cercek, Saibal Kar, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Background: As care and outcomes for acute myocardial infarction (MI) continue to improve, ventricular septal defect (VSD) remains a very serious mechanical complication of acute MI that is associated with high mortality and morbidity. Patients with post-MI VSD are often late presenting acute coronary syndrome cases or those receiving incomplete revascularization. Their presentation is often dramatic, including cardiogenic shock requiring support such as intravenous vasopressors, mechanical circulatory support (MCS), and/or intubation. Historically, the treatment is usually cardiothoracic surgical repair if the patient is stable enough to undergo surgery, which is associated with high mortality and morbidity. Transcatheter closure of post-MI VSD is an increasingly used alternative approach.
Methods and Results: Single center, retrospective cohort study of patients with post-MI VSD who were treated with transcatheter closure between 2005 and 2015 at Cedars-Sinai Medical Center. Twenty-one patients were included in the study (mean age 72±12 yo, 33% female). 15 (71%) patients were in heart failure, average NYHA functional class III to IV (3.7). 11 (52%) patients required mechanical circulatory device and 9 (43%) patients required intubation prior to their procedure. 2 patients were failed surgical closure prior to transcatheter VSD closure, 1 patient underwent surgical closure post VSD closure and expired during the procedure. A total of 29 closure devices were implanted. 5 (24%) patients underwent a second transcatheter closure procedure due to residual defect. Major procedurerelated complications occurred in 2 (0.7%) patients. The primary outcome of survival to discharge and 30 day survival occurred in 13 (62%) patients. The average length of hospitalization was (mean 15±18 d) and follow-up was (mean 157 ± 194 d). Conclusions: Transcather closure of post-myocardial infarction ventricular septal defect is a feasible and effective means of treatment and an alternative to cardiothoracic surgery. Early and often multiple interventions and closure devices are required to salvage these critically sick patients.
ACC.i2 Interventional Cardiology OUTCOMES OF TRANSCATHETER CLOSURE OF POST-MYOCARDIAL INFARCTION VENTRICULAR SEPTAL DEFECT Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 10:00 a.m.-10:45 a.m. Session Title: Acute Myocardial Infarction Abstract Category: 1. ACC.i2 Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology Presentation Number: 1105-118 Authors: Yu Xie, Justin Cox, Abhijeet Dhoble, Abhimanyu (Manu) Uberoi, Rahul Sharma, Tarun Chakravarty, William Collins, Raj Makkar, Fardad Esmailian, Prediman Shah, Bojan Cercek, Saibal Kar, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Background: As care and outcomes for acute myocardial infarction (MI) continue to improve, ventricular septal defect (VSD) remains a very serious mechanical complication of acute MI that is associated with high mortality and morbidity. Patients with post-MI VSD are often late presenting acute coronary syndrome cases or those receiving incomplete revascularization. Their presentation is often dramatic, including cardiogenic shock requiring support such as intravenous vasopressors, mechanical circulatory support (MCS), and/or intubation. Historically, the treatment is usually cardiothoracic surgical repair if the patient is stable enough to undergo surgery, which is associated with high mortality and morbidity. Transcatheter closure of post-MI VSD is an increasingly used alternative approach.
Methods and Results: Single center, retrospective cohort study of patients with post-MI VSD who were treated with transcatheter closure between 2005 and 2015 at Cedars-Sinai Medical Center. Twenty-one patients were included in the study (mean age 72±12 yo, 33% female). 15 (71%) patients were in heart failure, average NYHA functional class III to IV (3.7). 11 (52%) patients required mechanical circulatory device and 9 (43%) patients required intubation prior to their procedure. 2 patients were failed surgical closure prior to transcatheter VSD closure, 1 patient underwent surgical closure post VSD closure and expired during the procedure. A total of 29 closure devices were implanted. 5 (24%) patients underwent a second transcatheter closure procedure due to residual defect. Major procedurerelated complications occurred in 2 (0.7%) patients. The primary outcome of survival to discharge and 30 day survival occurred in 13 (62%) patients. The average length of hospitalization was (mean 15±18 d) and follow-up was (mean 157 ± 194 d). Conclusions: Transcather closure of post-myocardial infarction ventricular septal defect is a feasible and effective means of treatment and an alternative to cardiothoracic surgery. Early and often multiple interventions and closure devices are required to salvage these critically sick patients.