Longitudinal Outcomes After Surgical Repair of PostInfarction Ventricular Septal Defect in the Medicare population

Abstract Background Patients undergoing postinfarction ventricular septal defect (VSD) repair are at high risk for early morbidity and mortality, but little is known about subsequent clinical events. This study uses short-term clinical data from the Society of Thoracic Surgeons (STS) National Database linked with Medicare data to examine longer-term outcomes in these patients. Methods This was a retrospective review of the STS National Database to link with Medicare data all adults (≥65 years) who underwent VSD repair following a myocardial infarction between 2008-2012. The primary outcome was 1-year mortality. Risk factors for 1-year survival were modeled using a multivariable Cox regression. Results A total of 537 patients were identified using the STS database and medicare linkage. Median age was 74 years, and 277(52%) were men. 192(36%) were supported preoperatively with an intra-aortic balloon pump. Surgical status was emergent or salvage in 138(26%). 158(29%) died within 30-days and 207 (39%) patients died within 1-year. Among patients who survived to hospital discharge, 44% were discharged to a facility, and 172(32%) experienced at least one all-cause re-admission within 1-year. Unadjusted 1-year mortality rates were 13% for elective patients and 69% for emergency status (p Conclusions These data suggest the greatest mortality risk in this patient population occurs in the first 30-days. Emergency or salvage status strongly predicts 1-year mortality. Optimizing physiologic derangements prior to operative repair may be considered when possible in this subgroup of patients.