322: Surgical versus transcatheter closure for post-infarctus ventricular septal defect

IntroductionPost infarction ventricular septal defect (PIVSD) is a difficult to treat condition. Surgical closure is the first intention therapy but mortality rates remain high at 20-87% in current series. Transcatheter closure is a promising alternative although comparative studies are scarce. We describe our experience in 3 centers where surgery and transcatheter closure are available.MethodeBetween April 2006 and April 2012, 18 consecutive patients with PIVSD were initially treated surgically (n=10, group 1) or percutaneously (n=8, group 2). Three patients received both treatments.ResultsThirteen patients (72%) were admitted 12 hours or more after the onset of acute myocardial infarction (AMI) and 13 were in cardiogenic shock, with intra-aortic balloon pumpin 10 (55%) cases. Twelve (67%) had emergency percutaneous coronary intervention. Themedian delay between AMI and intervention was18,5 (3 to 828) days without difference between the 2 groups. Twelve patients (67%) underwent successful closure of their PIVSD without difference between surgical and percutaneous closure. A residual PIVSD was present in 12 cases, necessitating reintervention in 3 cases (17%). The overall mortality rate was 28% (5/18), including 3 (37,5%) cases after transcatheter and 2 (20%) after surgical closure (p NS). However, early (