Outcomes of post-mi vsr surgical repair in-patients operated in different time periods upon acute myocardial infarction evolvement
Authors: Aliyev Ramil , Lebedeva Yelizaveta , Mykhailo Grusha , Musayev Kamran 
Published: May 2022

Aim: The article highlights problematic issues of surgical treatment of mechanical complications of acute myocardial infarction (AMI), specifically, post-myocardial infarction ventricular septum rupture (post-MI VSR). Based on the study of the results of surgical treatment of post-MI VSR in patients with different terms of surgical intervention upon AMI evolvement, the most rational approach to ventricular septum defect (VSD) repair in such patients has been determined. Specifically, subject to hemodynamic stability in patients with post-MI VSR within the first two weeks after AMI evolvement, given the risk of mortality (42.1%), the wait-and-see tactics of surgical treatment is deemed a wise measure. Since the third week after AMI the stabilization of operative mortality rate (up to 10.5-15.8%) has been observed this lays the grounds for active surgical treatment tactics. Notably, analysis of the dynamics of echocardiographic characteristics and changes in the degree of tolerance to physical activity (PA) in patients with post-MI VSR who underwent surgery in different periods after AMI evolvement have been particularly addressed. It has been found that the probability of achievement the most favourable clinical condition corresponding to class I by New York Heart Association (NYHA) classification (χ2 (2, n=65) = 20,791; p<0,001) increases when patients performed are operated on in later periods after AMI. Thus, given the risk of mortality in the early post myocardial infarction period, the most appropriate measure in the tactics of managing patients with post-MI VSR is surgical intervention aimed at VSD repairing 2 weeks after AMI. Nonetheless, the decision on the necessity of emergency surgery patients with post-MI VSR must be also based on the potential stabilization of systemic hemodynamic system characteristics using drug therapy and endovascular practices.
Material and Methods: In the study we have presented the retrospectively analysis of data of 90 ischemic heart disease (IHD) patients with post-MI VSR complications. The age of post-MI VSR in-patients ranged from 29 to 81 (60.0 ± 9.6). Among such patients men prevailed (72.3%). Duration of hospitalization of those post-MI VSR from AMI onset varied from 1 to 462 days (n=90). Depending on the time of surgery to be performed after AMI suffered, all patients were divided into groups: group 1 – up to 28 days (n=28); group 2 – from 29 to 56 days n=26); group 3 – from 57 days (n=36). Among the 90 patients who participated in the study, the surgical treatment of post-MI VSR was used in 93.3% (n=84) of patients. LV aneurysm repair according to W. M. Dagget’s technique (14) was performed in 54.8% of patients (n=46), according to T. E. David’s technique (7) – in 36.9% of patients (n=31).
Results: Overall surgical mortality among 84 patients has been observed in 22.6% (n=19). In patients of group 1 there occurred 10 lethal cases, in group 2 there were 5, and in group 3 – there were 4 deaths ( n=84)observed. Starting from the 3rd week after AMI onset, significant decrease in operative mortality from 42.1% to 10.5-15.8% has been observed. Study of the dynamics of echocardiography characteristics show less marked changes in LVESV and LVEDV in group 1 compared to groups 2 and 3 testify, in the latter, in favor of completed post-infarction "heart remodeling" with LV aneurysm formed.
Conclusion: 1. When planning the scope of surgical intervention at a later date from AMI evolvement, account must be taken of individual dynamics of post-myocardial infarction "cardiac remodeling". 2. Postoperative decrease in ECHO values of LVESV, LVEDV and LVSV in patients with post-MI VSR speaks for the effectiveness of surgical intervention aimed at repairing VSD and restoring LV geometry. 3. The probability of achieving the most favorable NYHA class I clinical state increases when surgery is performed in patients at the later time after AMI suffered.