Perfil clínico-cirúrgico de pacientes operados por ruptura do septo interventricular pós-infarto do miocárdio Clinical and surgical profile of patients operated for postinfarction interventricular septal rupture

Abstract

OBJETIVOS: Estudar características clínicas, complicações e desfechos intra-hospitalares de pacientes operados por ruptura do septo interventricular pós-infarto. MÉTODOS: Estudo retrospectivo envolvendo 21 pacientes entre janeiro/1996 e junho/2009. Todas as operações foram realizadas na Divisão de Cirurgia Cardiovascular do Complexo Hospitalar HUOC/PROCAPE. RESULTADOS: Idade média dos pacientes foi de 62,81 anos (± 8,21), sendo 61,9% (n=13) do sexo masculino. Ruptura ocorreu, em média, 4,8 dias após o infarto. Foi observado choque cardiogênico em 57,1% (n=12) dos casos, sendo este fator de risco para óbito (100% com choque vs. 22,2% sem choque; POBJECTIVES: To study clinical features, complications and in-hospital outcomes of patients operated for postinfarction ventricular septal rupture. METHODS: A retrospective study involving 21 patients between January/1996 and June/2009. All operations were performed at the Division of Cardiovascular Surgery of Complexo Hospitalar HUOC/PROCAPE. RESULTS: Mean age of patients was 62.81 years (± 8.21), 61.9% (n = 13) were male. Rupture occurred on average 4.8 days after infarction. Cardiogenic shock was observed in 57.1% (n = 12), being risk factor for death (100% with shock vs. 22.2% without shock; P<0.001). Survivors had a higher mean ejection fraction compared to deaths (66.29% ± 4.61% versus 42.71% ± 4.79%, P <0.001). All were classified as high risk by the EuroSCORE, and the survivors had lower average score compared to deaths (6.57 ± 0.53 versus 10.93 ± 2.23; P <0.001). The majority (76.2%, n = 16) of the patients needed to use vasoactive drugs and 57.1% (n = 12) considered hemodynamically unstable. Need for vasoactive drugs was a risk factor for death (81.3% with vasoactive drugs versus 20% without vasoactive drugs, P = 0.025). Hemodynamic instability was also a risk factor for death (100% in the unstable group versus 22.2% in the stable group; P <0.001). The rate of in-hospital mortality was 66.7% (n = 14). CONCLUSIONS: The need for vasoactive drugs, hemodynamic instability and cardiogenic shock were associated with higher rates of mortality. Patients who had adverse outcomes had less ventricular function and higher score in the EuroSCORE. Mortality remains high

Keywords

• Comunicação interventricular
• Ruptura cardíaca pós-infarto
• Infarto do miocárdio
• Heart septal defects, ventricular
• Heart rupture, post-infarction
• Myocardial infarction