急性心筋梗塞後の心室隔壁のための遅延手術の戦略

背景：患者は、急性心筋梗塞（AMI）の急性期に脆弱な心筋組織または残留シャントから出血しやすいため、心室中隔穿孔（VSP）の外科的修復のタイミングが重要です。This study aimed to assess the results of delayed surgery for VSP performed 2 weeks after AMI. 方法：合計で、VSP（平均年齢：72.6±10.4歳; 13人の男性）の連続した機能障害後患者24人が2003年5月から2016年6月に手術を受けました。If we could not control heart failure and organ function worsened during that period, we performed emergency surgery.術後の結果には、合併症、30日間の死亡率、長期病院の死亡、再手術率、および病院死亡率の危険因子が含まれていました。We examined whether organ function was maintained by delaying the surgery. RESULTS: Of the 24 patients, 11 (45.8%) required emergency surgery, and 13 (54.2%) could wait 2 weeks for surgery.The average time from AMI onset to diagnosis of VSP was 4.5±1.6 days, and the average time from VSP diagnosis to surgery was 9.0±6.0 days;5 patients (20.8%) required resurgery for VSP due to residual shunt, recurrent VSP, or pseudoaneurysm of the left ventricle.The 30-day mortality rate was 4.2% (1 patient), and long-term hospital mortality rate was 12.5% (3 patients).臓器機能は、選択的手術を受けた10人の患者（76.9％）で維持され、手術を遅らせることによって臓器の機能障害は進行しませんでした。 結論：臓器機能の悪化なしに、IABPまたは呼吸管理によるVSP発症から平均9日間手術を遅らせることができます。The 30-day mortality and long-term outcome were favorable.

BACKGROUND: The timing of surgical repair for ventricular septal perforation (VSP) is important because patients are susceptible to bleeding from fragile myocardial tissue or residual shunt during the acute phase of acute myocardial infarction (AMI). This study aimed to assess the results of delayed surgery for VSP performed 2 weeks after AMI. METHODS: In total, 24 consecutive postinfarction patients with VSP (mean age: 72.6±10.4 years; 13 males) underwent operation between May 2003 and June 2016. We postponed surgery during the acute phase and performed an elective surgery if the patient could wait for 2 weeks with support from intra-aortic balloon pumping (IABP) and respiratory management. If we could not control heart failure and organ function worsened during that period, we performed emergency surgery. Postoperative outcomes included complications, 30-day mortality rate, long-term hospital death, reoperation rate, and risk factors for hospital mortality. We examined whether organ function was maintained by delaying the surgery. RESULTS: Of the 24 patients, 11 (45.8%) required emergency surgery, and 13 (54.2%) could wait 2 weeks for surgery. The average time from AMI onset to diagnosis of VSP was 4.5±1.6 days, and the average time from VSP diagnosis to surgery was 9.0±6.0 days; 5 patients (20.8%) required resurgery for VSP due to residual shunt, recurrent VSP, or pseudoaneurysm of the left ventricle. The 30-day mortality rate was 4.2% (1 patient), and long-term hospital mortality rate was 12.5% (3 patients). Organ function was maintained in 10 patients (76.9%) who underwent elective surgery, and organ dysfunction was not advanced by delaying the surgery. CONCLUSIONS: We could delay surgery for an average of 9 days from VSP onset by means of IABP or respiratory management without the deterioration of organ function. The 30-day mortality and long-term outcome were favorable.