Importance of coronary revascularization for late survival after postinfarction ventricular septal rupture. A reason to perform coronary angiography prior to surgery.

BACKGROUND: No consistent data are available on the specific coronary artery pathology leading to postinfarction ventricular septal rupture. The benefits and risks of coronary angiography and subsequent coronary artery bypass grafting in these patients is under discussion.

METHODS: Clinical and coronary angiographic factors were analysed in 109 consecutive patients treated surgically for postinfarction ventricular septal rupture between 1980 and 1992. Coronary angiography was performed in 104 patients, and 92 of the angiograms were available for complete analysis. Factors were related to late cardiac mortality in 79 patients surviving the early period.

RESULTS: Single-vessel disease was found in 58 patients (55.8%) and multiple-vessel in 46 (44.2%). In 24 patients (26.1%) there was some collateral circulation to the infarct-related coronary artery. No relationship was found between dominance, occlusion location and early or late outcome. Forty-five patients (41.3%) underwent coronary revascularization in addition to surgical closure of the ventricular septal rupture. Risk factors for late cardiac mortality in patients surviving the early postoperative period were postoperative cardiac failure (P = 0.0089), incomplete coronary revascularization (P = 0.024) and longer aortic cross-clamp time (P = 0.032).

CONCLUSION: We conclude that concomitant complete revascularization is indicated during surgical repair of postinfarction ventricular septal rupture.