Blood perfusion status is important in the prognosis of ventricular aneurysm complicated by ventricular septal rupture

Abstract

Abstract Aims Due to its low incidence, poor prognosis, and high mortality in the acute phase, the long‐term prognosis of the left ventricular aneurysm (LVA) complicated by ventricular septal rupture (VSR) has received little attention. This study focus on the long‐term prognosis of patients with LVA complicated by relatively stable VSR. Methods and results Over a decade of retrospection, 68 patients with both LVA and VSR were compared with 136 patients with LVA alone after propensity score matching. Patients with both LVA and VSR were further divided into two groups depending on whether pre‐operative intra‐aortic balloon pump (IABP) was used (23 pre‐operative IABP vs. 45 non‐pre‐operative IABP). The primary endpoint was defined as major adverse cardiovascular and cerebrovascular events, a composite endpoint including mortality, myocardial infarction, revascularization, stroke, and heart failure. Patients with both LVA and VSR were generally in a worse condition upon admission compared with those with LVA alone [percentage of patients in New York Heart Association IV: 42.6% (29/68) vs. 11.0% (15/136), P < 0.001]. Both pre‐operative and post‐operative IABP use rates were significantly higher in patients with both LVA and VSR than in patients with LVA alone [pre‐operative IABP use rates: 33.8% (23/68) vs. 0.74% (1/136), P < 0.001 and post‐operative IABP use rates: 33.8% (23/68) vs. 10.3% (14/136), P < 0.001]. No significant difference was observed in the primary endpoint between patients with both LVA and VSR and those with LVA alone (log‐rank test, P = 0.63, median follow‐up time 63 months). We further investigated the effect of pre‐operative IABP on the long‐term prognosis of patients with both LVA and VSR. Patients who applied pre‐operative IABP had a worse long‐term prognosis than those who did not (log‐rank test, P = 0.0011). Conclusions The long‐term prognosis of LVA combined with VSR was not inferior than LVA alone after surgery, but poor blood perfusion status was associated with a worse prognosis.

Keywords

• Cardiac surgery
• IABP
• Left ventricular aneurysm
• Ventricular septal rupture