Selection of conduits for coronary artery bypass grafting during surgical repair of ventricular septal rupture_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MA Jiexu , XU Xinhe , XU Hang , ZHONG Zhaoji ,  LIU Sheng

Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding author：

LIU Sheng, Email: liusheng@fuwai.com

Keywords：

Coronary artery disease; ventricular septal rupture; surgery; coronary artery bypass grafting; arterial conduit

DOI：

10.7507/1007-4848.202412003

Video：

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Objective To investigate the impact of graft type on perioperative outcomes and long-term prognosis in patients undergoing surgical repair of post-myocardial infarction ventricular septal rupture (VSR) with concomitant coronary artery bypass grafting (CABG). Methods A retrospective analysis was conducted on clinical data from patients who underwent VSR repair and simultaneous CABG at Fuwai Hospital between 2005 and 2022. Patients were divided into an arterial graft group and a saphenous vein graft (SVG)-only group based on the type of bypass grafts used. Clinical outcomes were compared between the two groups. Results A total of 92 patients were included, comprising 56 males and 36 females, with a mean age of (62.4±7.9) years. The arterial graft group consisted of 60 patients, and the SVG-only group consisted of 32 patients. There were no statistical differences between the two groups in baseline characteristics, time interval from myocardial infarction to surgery, or culprit vessel distribution (P>0.05). A higher proportion of patients in the SVG-only group received preoperative intra-aortic balloon pump (IABP) support (56.3% vs. 35.0%, P=0.049). However, cardiopulmonary bypass time, aortic cross-clamp time, and early mortality rates were similar between the two groups (P>0.05). Follow-up data revealed no statistically significant differences in cumulative 10-year survival (82.8% vs. 80.0%, P=0.940) or freedom from major adverse cardiovascular and cerebrovascular events (MACCE) (49.6% vs. 58.6%, P=0.491) between the SVG-only and arterial graft groups. Furthermore, graft type did not significantly affect long-term mortality in patients with a culprit vessel in the left anterior descending artery or those with multivessel disease. Conclusion In patients undergoing delayed repair of VSR with concomitant CABG, the use of arterial or saphenous vein grafts did not significantly impact perioperative outcomes or long-term prognosis. Future research should further explore the benefits of different revascularization strategies to optimize treatment for this population.

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2.	Sanmartín-Fernández M, Raposeiras-Roubin S, Anguita-Sánchez M, et al. In-hospital outcomes of mechanical complications in acute myocardial infarction: Analysis from a nationwide Spanish database. Cardiol J, 2021, 28(4): 589-597.
3.	Elbadawi A, Elgendy IY, Mahmoud K, et al. Temporal trends and outcomes of mechanical complications in patients with acute myocardial infarction. JACC Cardiovasc Interv, 2019, 12(18): 1825-1836.
4.	Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J, 2023, 44(38): 3720-3826.
5.	Schlotter F, Huber K, Hassager C, et al. Ventricular septal defect complicating acute myocardial infarction: diagnosis and management. A Clinical Consensus Statement of the Association for Acute CardioVascular Care (ACVC) of the ESC, the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC and the ESC Working Group on Cardiovascular Surgery. Eur Heart J, 2024, 45(28): 2478-2492. 6 , Lawton JS, Tamis-Holland JE, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol, 2022, 79(2): e21-e129.
6.	Hlatky MA, Boothroyd DB, Reitz BA, et al. Adoption and effectiveness of internal mammary artery grafting in coronary artery bypass surgery among Medicare beneficiaries. J Am Coll Cardiol, 2014, 63(1): 33-39.
7.	Goldstone AB, Chiu P, Baiocchi M, et al. Second arterial versus venous conduits for multivessel coronary artery bypass surgery in California. Circulation, 2018, 137(16): 1698-1707.
8.	Lundblad R, Abdelnoor M, Geiran OR, et al. Surgical repair of postinfarction ventricular septal rupture: Risk factors of early and late death. J Thorac Cardiovasc Surg, 2009, 137(4): 862-868.
9.	Deja MA, Szostek J, Widenka K, et al. Post infarction ventricular septal defect - Can we do better? Eur J Cardiothorac Surg, 2000, 18(2): 194-201.
10.	Belyaev AM, Skopin II, Lobacheva GV, et al. Complete anatomic surgical myocardial revascularisation during postinfarction ventricular septal defect and ventricular aneurysm repair is associated with improved short- and long-term outcomes. J Card Surg, 2022, 37(9): 2693-2702.
11.	Giblett JP, Matetic A, Jenkins D, et al. Post-infarction ventricular septal defect: Percutaneous or surgical management in the UK national registry. Eur Heart J, 2022, 43(48): 5020-5032.
12.	Ronco D, Matteucci M, Kowalewski M, et al. Surgical treatment of postinfarction ventricular septal rupture. JAMA Netw Open, 2021, 4(10): e2128309.
13.	Arnaoutakis GJ, Zhao Y, George TJ, et al. Surgical repair of ventricular septal defect after myocardial infarction: Outcomes from the Society of Thoracic Surgeons National Database. Ann Thorac Surg, 2012, 94(2): 436-443.
14.	Gaba P, Gersh BJ, Ali ZA, et al. Complete versus incomplete coronary revascularization: Definitions, assessment and outcomes. Nat Rev Cardiol, 2021, 18(3): 155-168.
15.	Ronco D, Corazzari C, Matteucci M, et al. Effects of concomitant coronary artery bypass grafting on early and late mortality in the treatment of post-infarction mechanical complications: A systematic review and meta-analysis. Ann Cardiothorac Surg, 2022, 11(3): 210-225.
16.	Horan DP, O'Malley TJ, Weber MP, et al. Repair of ischemic ventricular septal defect with and without coronary artery bypass grafting. J Card Surg, 2020, 35(5): 1062-1071.
17.	Cubeddu RJ, Lorusso R, Ronco D, et al. Ventricular septal rupture after myocardial infarction: JACC Focus Seminar 3/5. J Am Coll Cardiol, 2024, 83(19): 1886-1901.
18.	Al-Bulushi A, Salmi IA, Ahmed AR, et al. Post-infarction ventricular septal defect: A quarter century experience. Sultan Qaboos Univ Med J, 2023, 23(Spec Iss): 22-30.
19.	Dalrymple-Hay MJ, Monro JL, Livesey SA, et al. Postinfarction ventricular septal rupture: The Wessex experience. Semin Thorac Cardiovasc Surg, 1998, 10(2): 111-116.
20.	Ronco D, Ariza-Solé A, Kowalewski M, et al. The current clinical practice for management of post-infarction ventricular septal rupture: A European survey. Eur Heart J Open, 2023, 3(5): oead091.
21.	张岩, 杨研, 杨克明, 等. 急性心肌梗死合并室间隔穿孔的近中期外科疗效分析. 中国心血管病研究, 2019, 17(6): 547-550.Zhang Y, Yang Y, Yang KM, et al. Early and mid-term results of surgical effects of acute myocardial infarction complicated with ventricular septal perforation. Chinese Journal of Cardiovascular Review, 2019, 17(6): 547-550.
22.	Jeppsson A, Liden H, Johnsson P, et al. Surgical repair of post infarction ventricular septal defects: A national experience. Eur J Cardiothorac Surg, 2005, 27(2): 216-221.
23.	Cameron A, Davis KB, Green G, et al. Coronary bypass surgery with internal-thoracic-artery grafts--Effects on survival over a 15-year period. N Engl J Med, 1996, 334(4): 216-219.
24.	Perrotta S, Lentini S. In patients undergoing surgical repair of post-infarction ventricular septal defect, does concomitant revascularization improve prognosis? Interact Cardiovasc Thorac Surg, 2009, 9(5): 879-887.

1. Puerto E, Viana-Tejedor A, Martínez-Sellés M, et al. Temporal trends in mechanical complications of acute myocardial infarction in the elderly. J Am Coll Cardiol, 2018, 72(9): 959-966.
2. Sanmartín-Fernández M, Raposeiras-Roubin S, Anguita-Sánchez M, et al. In-hospital outcomes of mechanical complications in acute myocardial infarction: Analysis from a nationwide Spanish database. Cardiol J, 2021, 28(4): 589-597.
3. Elbadawi A, Elgendy IY, Mahmoud K, et al. Temporal trends and outcomes of mechanical complications in patients with acute myocardial infarction. JACC Cardiovasc Interv, 2019, 12(18): 1825-1836.
4. Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J, 2023, 44(38): 3720-3826.
5. Schlotter F, Huber K, Hassager C, et al. Ventricular septal defect complicating acute myocardial infarction: diagnosis and management. A Clinical Consensus Statement of the Association for Acute CardioVascular Care (ACVC) of the ESC, the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC and the ESC Working Group on Cardiovascular Surgery. Eur Heart J, 2024, 45(28): 2478-2492. 6 , Lawton JS, Tamis-Holland JE, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol, 2022, 79(2): e21-e129.
6. Hlatky MA, Boothroyd DB, Reitz BA, et al. Adoption and effectiveness of internal mammary artery grafting in coronary artery bypass surgery among Medicare beneficiaries. J Am Coll Cardiol, 2014, 63(1): 33-39.
7. Goldstone AB, Chiu P, Baiocchi M, et al. Second arterial versus venous conduits for multivessel coronary artery bypass surgery in California. Circulation, 2018, 137(16): 1698-1707.
8. Lundblad R, Abdelnoor M, Geiran OR, et al. Surgical repair of postinfarction ventricular septal rupture: Risk factors of early and late death. J Thorac Cardiovasc Surg, 2009, 137(4): 862-868.
9. Deja MA, Szostek J, Widenka K, et al. Post infarction ventricular septal defect - Can we do better? Eur J Cardiothorac Surg, 2000, 18(2): 194-201.
10. Belyaev AM, Skopin II, Lobacheva GV, et al. Complete anatomic surgical myocardial revascularisation during postinfarction ventricular septal defect and ventricular aneurysm repair is associated with improved short- and long-term outcomes. J Card Surg, 2022, 37(9): 2693-2702.
11. Giblett JP, Matetic A, Jenkins D, et al. Post-infarction ventricular septal defect: Percutaneous or surgical management in the UK national registry. Eur Heart J, 2022, 43(48): 5020-5032.
12. Ronco D, Matteucci M, Kowalewski M, et al. Surgical treatment of postinfarction ventricular septal rupture. JAMA Netw Open, 2021, 4(10): e2128309.
13. Arnaoutakis GJ, Zhao Y, George TJ, et al. Surgical repair of ventricular septal defect after myocardial infarction: Outcomes from the Society of Thoracic Surgeons National Database. Ann Thorac Surg, 2012, 94(2): 436-443.
14. Gaba P, Gersh BJ, Ali ZA, et al. Complete versus incomplete coronary revascularization: Definitions, assessment and outcomes. Nat Rev Cardiol, 2021, 18(3): 155-168.
15. Ronco D, Corazzari C, Matteucci M, et al. Effects of concomitant coronary artery bypass grafting on early and late mortality in the treatment of post-infarction mechanical complications: A systematic review and meta-analysis. Ann Cardiothorac Surg, 2022, 11(3): 210-225.
16. Horan DP, O'Malley TJ, Weber MP, et al. Repair of ischemic ventricular septal defect with and without coronary artery bypass grafting. J Card Surg, 2020, 35(5): 1062-1071.
17. Cubeddu RJ, Lorusso R, Ronco D, et al. Ventricular septal rupture after myocardial infarction: JACC Focus Seminar 3/5. J Am Coll Cardiol, 2024, 83(19): 1886-1901.
18. Al-Bulushi A, Salmi IA, Ahmed AR, et al. Post-infarction ventricular septal defect: A quarter century experience. Sultan Qaboos Univ Med J, 2023, 23(Spec Iss): 22-30.
19. Dalrymple-Hay MJ, Monro JL, Livesey SA, et al. Postinfarction ventricular septal rupture: The Wessex experience. Semin Thorac Cardiovasc Surg, 1998, 10(2): 111-116.
20. Ronco D, Ariza-Solé A, Kowalewski M, et al. The current clinical practice for management of post-infarction ventricular septal rupture: A European survey. Eur Heart J Open, 2023, 3(5): oead091.
21. 张岩, 杨研, 杨克明, 等. 急性心肌梗死合并室间隔穿孔的近中期外科疗效分析. 中国心血管病研究, 2019, 17(6): 547-550.Zhang Y, Yang Y, Yang KM, et al. Early and mid-term results of surgical effects of acute myocardial infarction complicated with ventricular septal perforation. Chinese Journal of Cardiovascular Review, 2019, 17(6): 547-550.
22. Jeppsson A, Liden H, Johnsson P, et al. Surgical repair of post infarction ventricular septal defects: A national experience. Eur J Cardiothorac Surg, 2005, 27(2): 216-221.
23. Cameron A, Davis KB, Green G, et al. Coronary bypass surgery with internal-thoracic-artery grafts--Effects on survival over a 15-year period. N Engl J Med, 1996, 334(4): 216-219.
24. Perrotta S, Lentini S. In patients undergoing surgical repair of post-infarction ventricular septal defect, does concomitant revascularization improve prognosis? Interact Cardiovasc Thorac Surg, 2009, 9(5): 879-887.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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