Contributors: Maastricht University Medical Centre (MUMC); Maastricht University Maastricht; Universitá degli Studi dell’Insubria = University of Insubria Varese (Uninsubria); Central Clinical Hospital of the Ministry of the Interior & Administration Warsaw, Poland (2CHMIA); Ministry of the Interior and Administration Warsaw, Poland (MIA); Universita Vita Salute San Raffaele = Vita-Salute San Raffaele University Milan, Italie (UniSR); Università degli Studi di Milano-Bicocca = University of Milano-Bicocca (UNIMIB); Università degli studi di Parma = University of Parma (UNIPR); Università degli Studi "Magna Graecia" di Catanzaro = University of Catanzaro (UMG); Università degli Studi di Milano = University of Milan (UNIMI); CHU Henri Mondor Créteil; Innsbruck Medical University = Medizinische Universität Innsbruck (IMU); Niguarda Hospital Milan, Italy; Università degli Studi di Udine - University of Udine Italie; University of Pisa - Università di Pisa; Klinikum Nürnberg Nord; Paracelsus Medizinische Privatuniversität = Paracelsus Medical University (PMU); Fondazione Poliambulanza; Mauriziano Umberto Hospital Turin, Italy (MUH); King Fahad Medical City Riyadh, Saudi Arabia; Luigi Sacco University Hospital Milan; Medical University of Silesia (SUM); Upper Silesian Medical Centre Katowice, Poland (USMC); West German Heart Center; Universität Duisburg-Essen = University of Duisburg-Essen Essen; University Hospitals Leuven Leuven; King Faisal Specialist Hospital and Resarch Centre Riyadh, Saudi Arabia (KFSHRC); Golden Jubilee National Hospital, Glasgow; Hôpital Louis Pradel CHU - HCL; Hospices Civils de Lyon (HCL); Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN); Université Claude Bernard Lyon 1 (UCBL); Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE); University Hospital Düsseldorf; Hospital Papa Giovanni XXIII (Hosp P Giovanni XXIII); University Heart Center Hamburg; Cardiovascular Research Institute Maastricht (CARIM)
نبذة مختصرة : International audience ; IMPORTANCE: Ventricular septal rupture (VSR) is a rare but life-threatening mechanical complication of acute myocardial infarction associated with high mortality despite prompt treatment. Surgery represents the standard of care; however, only small single-center series or national registries are usually available in literature, whereas international multicenter investigations have been poorly carried out, therefore limiting the evidence on this topic. OBJECTIVES: To assess the clinical characteristics and early outcomes for patients who received surgery for postinfarction VSR and to identify factors independently associated with mortality. DESIGN, SETTING, AND PARTICIPANTS: The Mechanical Complications of Acute Myocardial Infarction: an International Multicenter Cohort (CAUTION) Study is a retrospective multicenter international cohort study that includes patients who were treated surgically for mechanical complications of acute myocardial infarction. The study was conducted from January 2001 to December 2019 at 26 different centers worldwide among 475 consecutive patients who underwent surgery for postinfarction VSR. EXPOSURES: Surgical treatment of postinfarction VSR, independent of the technique, alone or combined with other procedures (eg, coronary artery bypass grafting). MAIN OUTCOMES AND MEASURES: The primary outcome was early mortality; secondary outcomes were postoperative complications. RESULTS: Of the 475 patients included in the study, 290 (61.1%) were men, with a mean (SD) age of 68.5 (10.1) years. Cardiogenic shock was present in 213 patients (44.8%). Emergent or salvage surgery was performed in 212 cases (44.6%). The early mortality rate was 40.4% (192 patients), and it did not improve during the nearly 20 years considered for the study (median [IQR] yearly mortality, 41.7% [32.6%-50.0%]). Low cardiac output syndrome and multiorgan failure were the most common causes of death (low cardiac output syndrome, 70 [36.5%]; multiorgan failure, 53 [27.6%]). Recurrent VSR occurred ...
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