POSTINFARCTION VENTRICULAR SEPTAL DEFECT: RISK FACTORS FOR WORSE OUTCOME, A MULTICENTRIC INTERNATIONAL STUDY.

Background and Aim: Even in the percutaneous coronary intervention era, surgery still remains the treatment of choice of ischemic ventricular septal defect. Most of the previous data come from single centre studies. The aim of our study was to investigate risk factors for worse outcome. Methods: We conducted a retrospective, multi-center study. One-hundred eleven patients from four centers, who underwent surgery for a post-myocardial infarction ventricular septal defect in the period 2001-2021, were enrolled. The study was conducted on behalf of the Gruppo Italiano di Ricerca sugli Outcome in Cardiochirurgia. Results: Early timing of surgery (p-value 0.248), concomitant surgical intervention (p-value 0.121), pre- operative cardiac arrest (p-value 0.150), emergency surgery (p-value 0.888) were not statistically associated with a worse outcome. Serum creatinine (p-value 0.025), pre-operative implant of intra-aortic balloon pump (p-value 0.015) and, notably, bleeding during the first 48 hours (p- value0.026) were higher in the in-hospital death group. Overall, in-hospital mortality was 39% (44 patients). Conclusions: Despite high risk and high mortality rate, surgery still remains the treatment of choice for post- infarction ventricular septal defect. Bypassing the bias of a single centre evaluation, our results seem to suggest that regardless of the institution, early surgery, concomitant surgical procedure, emergency surgery, pre-operative cardiac arrest are not linked to a worse outcome, while renal impairment, pre-operative intra-aortic balloon pump and bleeding during the first 48 hours are related to in-hospital mortality.