Surgery of postinfarction ventricular septal rupture: the effect of David infarct exclusion versus Daggett direct septal closure on early and late outcomes.

OBJECTIVE: David infarct exclusion and Daggett direct septal closure are alternative techniques to repair postinfarction ventricular septal rupture. The aim of the present study was to compare the 2 methods with regard to postoperative morbidity, 30-day mortality, and long-term survival.

METHODS: From May 1981 to December 2010, 110 patients underwent surgery for postinfarction ventricular septal rupture. Data were collected on the clinical, angiographic, and echocardiographic findings, operative procedures, early morbidity, and survival time. The epidemiologic design was of an exposed (David infarct exclusion, n = 42) versus a nonexposed (Daggett direct closure, n = 68) cohort with 3 endpoints: postoperative morbidity, 30-day mortality, and long-term survival. The crude effect of the repair technique versus the endpoint was estimated using univariate statistics. Stratification analysis using the Mantel-Haenszel method was done to quantify the confounders and pinpoint the effect modifiers. Adjustment for confounders was performed using logistic regression and Cox regression analysis, and with propensity score stratification statistics. Survival curves were analyzed using the Breslow test and log-rank test.

RESULTS: The surgical technique had no influence on postoperative morbidity. The 30-day mortality was 16.7% in the David group and 48.5% in the Daggett group (P = .000). Long-term survival was greater after David than after Daggett, with 5- and 10-year survival of 69% versus 38% and 48% versus 27%, respectively (P = .004). Total coronary revascularization improved survival more in the David than in the Daggett group.

CONCLUSIONS: David infarct exclusion was superior to Daggett direct septal closure for early and late survival after surgery for postinfarction ventricular septal rupture. Total coronary revascularization improved survival more in the David than in the Daggett group.