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- Title
Percutaneous Closure of Post-Infarction Ventricular Septal Defects-An Over Decade-long Experience.
- Authors
Sabiniewicz, Robert; Huczek, Zenon; Zbroński, Karol; Scisło, Piotr; Rymuza, Bartosz; Kochman, Janusz; Marć, Miłosz; Grygier, Marek; Araszkiewicz, Aleksander; Dziarmaga, Mieczysław; Leśniewicz, Piotr; Hiczkiewicz, Jarosław; Kidawa, Michał; Filipiak, Krzysztof J.; Opolski, Grzegorz
- Abstract
<bold>Objectives: </bold>To report an over decade-long experience with percutaneous post-infarction ventricular septal defect (PIVSD) closure.<bold>Background: </bold>PIVSDs remains a major clinical challenge with extremely high mortality. Data concerning interventional closure of PIVSD is scarce.<bold>Methods: </bold>All percutaneous PIVSD closures performed between 2003 and 2016 in 8 participating centres were identified. Data concerning patients and procedures was acquired. Patients were divided into two groups, based on the time interval between VSD diagnosis and closure (≤14 days-acute phase, >14 days-non-acute phase).<bold>Results: </bold>Twenty-one percutaneous PIVSD closures were performed on 20 patients (9 females, mean age: 70 years). Mean interval between the diagnosis and the procedure was 182.6 ± 500 days (range: 7-2228). Defects were mostly located in apical (55%) segments of the septum. In 7 cases (33%) the procedure was performed in the acute phase. The closure was technically successful in 17 cases (81%). Four patients died within 48 hours after the procedure. 30-days survival rate of the entire cohort was 70%. Univariate analysis revealed impact of technical success of the procedure (HR 0.13, CI 0.03-0.68 P = 0.016) and white blood cell count (HR 1.36 per unit increase, CI 1.1-1.69, P = 0.005) on 30-day mortality.<bold>Conclusions: </bold>In a selected population of patients percutaneous PIVSD closure is feasible and provides satisfactory survival rate. Procedural success has a protective impact on survival. Timing of the closure remains controversial. Procedure in the non-acute phase carries lower mortality, but at the same time introduces a selection bias. Larger registry-based studies are required.
- Subjects
PERCUTANEOUS coronary intervention; VENTRICULAR septal defects; PULMONARY infarction; HEART disease related mortality; PATIENTS; MYOCARDIAL infarction complications; MYOCARDIAL infarction-related mortality; MYOCARDIAL infarction treatment; CARDIAC catheterization; CARDIOVASCULAR system; LONGITUDINAL method; MEDICAL care; TREATMENT effectiveness
- Publication
Journal of Interventional Cardiology, 2017, Vol 30, Issue 1, p63
- ISSN
0896-4327
- Publication type
journal article
- DOI
10.1111/joic.12367