Clinical Analysis Of Different Treatment Methods For Ventricular Septal Perforation After Acute Myocardial Infarction

Objective:To analyze the clinical features and results follow-up of patients with postinfarction ventricular septal rupture treated with conservative drug treatment,surgical repair and interventional occlusion,and to guide the treatment of patients with ventricular septal perforation after acute myocardial infarction.Materials and Methods:A retrospective analysis of the clinical data of 110 patients who were diagnosed with PIVSR at the Heart Center of Henan Provincial People’s Hospital from January2017 to October 2020.Among them,there were 46 cases in the conservative drug treatment group,50 cases in the interventional occlusion group and14 cases in the surgical repair group.Analysis of three groups of patients with clinical basic data,follow-up ending and interventional closure and surgical repair of the preoperative,intraoperative and postoperative results.Cox regression model was used to analyze the risk factors affecting postoperative survival in patients with PIVSR.Kaplan-Meier curves of mortality event-free survival in the drug therapy group,interventional occlusion group and surgical group were calculated,and log-rank test was used to compare the mortality free survival in the two endpoints.Results:1 Among the 110 patients with postinfarction ventricular septal rupturewho met the inclusion criteria,48 were males and 62 were females,with an average age of(68.1±8.5)years.Most of them were complicated with hypertension,ventricular aneurysm,and cardiac function grade III-IV(Killip grade).Most of them had no history of smoking,old myocardial infarction or diabetes.Most of the criminal vessels were anterior descending branches,which were manifested as anterior wall and xtensive anterior wall myocardial infarction.There was no statistical significance in clinical basic data among the three groups(P>0.05).2 All surgical patients underwent echocardiography after admission,and the left ventricular ejection fraction(LVEF)of the drug treatment group was(43.5±10.8),that of the interventional occlusion group was(49.4±7.8),and that of the surgical surgery group was(53.1±7.5),with significant difference among the three groups(P=0.001).The diameter of perforation was(13.0±4.6)in the drug treatment group,(11.9±4.1)in the interventional occlusion group and(24.3±8.7)in the surgical operation group,and the difference was statistically significant(P=0.001).However,there were no significant differences in left ventricular end-systolic volume(LVEDD),mitral regurgitation area and tricuspid regurgitation area among the three groups(P>0.05).3 In the interventional occlusion group,the operative time was shorter by 50.0(50.0,60.0)vs396.0(285.0,474.0),ICU retention time was shorter by 3.0(2.0,4.0)vs5.6(3.9,13.1),the hospitalization cost was lower [(15.9±9.5)vs(39.6±15.7)],and the proportion of postoperative residual shunts was higher(92.0%vs42.0%).Compared with the surgical repair group,the difference was statistically significant(P < 0.05).There were no significant differences in postoperative hospital stay,in-hospital death and renal dialysis treatment between the two groups(P>0.05).4 Fifty-two patients in the interventional plugging group and the surgical group were followed up for 6 months.Follow-up results showed that there were no significant differences in left ventricular shumer diameter(LVEDD),left ventricular ejection fraction(LVEF)and 6min walk test between the interventional occlusion group and the surgical operation group 1 month and 6 months after surgery(P>0.05).5 The mortality rate in 1 month was 86.0% in drug therapy group,16.0% in interventional occlusion group and 28.6% in surgical repair operation group,respectively.No deaths,according to the results of the curve of the Kaplan Meier-survival of drug treatment group compared with interventional closure surgical treatment group and the deaths of follow-up survival difference to be markedly,with statistical significance(P < 0.05),interventional closure group and the surgical treatment and follow-up of deaths surial differences no statistical difference(P =0.21),and surgical treatment significantly reduce the mortality rate of patients with PIVSR.6 Cox multivariate regression analysis showed that heart function grade III-IV(Killip grade)was a risk factor affecting the survival of patients in the intervinterous occlusion and surgical group(P=0.022),and there was no significant difference in the time to operation,operation method and perforation diameter between the two groups of patients of the survival rate(P>0.05).Conclusion1 Cardiac function grade III-IV(Killip grade)is a risk factor affecting the survival of patients in the interventional occlusion group and the surgical repair group,and active improvement of cardiac function can improve the survival rate of patients.Interventional closure or surgical intervention after 2 weeks of perforation does not affect the survival rate of the patient.2 Conservative drug therapy alone has poor effect,and surgical intervention is still an important treatment for PIVSR patients,which can significantly improve the survival rate of patients.3 The short and medium term survival rate of interventional occlusion is better than that of surgery.As a simple,less invasive and better prognosis treatment,interventional occlusion is likely to become a valuable alternative treatment for surgery,but it still needs to be further confirmed by long-term follow-up.