Surgical Repair of Post-Infarction Ventricular Septal Rupture: Systematic Review and Meta-Analysis.

BACKGROUND Ventricular septal rupture (VSR) is a rare but life-threatening complication following acute myocardial infarction. Surgical correction, though challenging and associated with high mortality, remains the treatment of choice. This systematic review and meta-analysis aimed to evaluated the early outcome of surgical VSR repair. METHODS Electronic databases were searched from January 1998 to February 2020. Studies reporting patients undergoing surgical treatment for VSR were analysed. The primary outcome being assessed was operative mortality. Differences were expressed as odds ratio (OR) with 95% confidence interval (CI) to assess the relationships of predefined surgical variables and clinical prognosis. RESULTS A total of 6,361 adult patients from 41 studies were identified. Operative mortality was 38.2%. Pooled ORs showed increased odds of operative mortality in patients with pre/perioperative IABP insertion (OR, 3.48; 95%CI, 3.01 to 4.02; p < 0.001), right ventricular (RV) dysfunction (OR, 2.85; 95%CI, 1.47 to 5.52; p = 0.002), posterior VSR (OR, 1.73; 95%CI, 1.30 to 2.31; p < 0.001), and emergency surgery (OR, 3.79; 95%CI, 2.52 to 5.72; p < 0.001). Temporal trend evaluation revealed no difference over time in the operative mortality rate, being 34% in both time-related groups (years 1971-2000 versus years 2001-2018). CONCLUSIONS VSR repair carries a high operative mortality. Patients with pre/perioperative IABP support, RV dysfunction at presentation, posterior defects, and subjects undergoing VSR correction on emergency basis have increased odds of operative mortality.