Optimal Timing of Surgery and Analysis of Prognostic Factors for Myocardial Infarction Complicated by Ventricular Septal Rupture

Background: The optimal surgical timing for ventricular septal rupture (VSR) complicating acute myocardial infarction (MI) remains controversial, and evidence on safe bridging strategies to delay surgery is limited. This study sought to investigate the optimal timing for surgical treatment and to identify factors influencing postoperative mortality.

Methods: A retrospective analysis was conducted on the clinical data of 138 patients who underwent surgical repair for post-MI VSR at Beijing Anzhen Hospital between January 2008 and June 2025. The study aimed to determine the optimal surgical timing and to identify the factors associated with postoperative mortality using least absolute shrinkage and selection operator (LASSO) regression.

Results: We included 138 patients (87 men; mean age 64.8±9.4 years). Perioperative mortality was 17.3% (24/138). Surgery performed on or after day 8 following VSR was associated with lower perioperative mortality. LASSO and multivariable logistic regression identified opened IRA and VSR-to-surgery ≥8 days as independent protective factors. A LASSO regression analysis of the preoperative variables identified preoperative opened by percutaneous infarct-related artery (IRA) and a VSR-to-surgery interval of ≥ 8 days as independent factors associated with postoperative mortality. Further analysis revealed that an opened IRA was associated with a significantly increased likelihood of survival to ≥ 8 days (P=0.046). Regardless of whether opened IRA was performed before or after VSR, most patients survived to undergo surgery beyond day8 (72.5% vs. 86.5%, P=0.139), and the opened IRA timing (pre- or post-VSR) was not associated with perioperative mortality. With a median follow-up of 6.5 years (range: 0.1–16.5 years), the cumulative survival rates at 2, 5, 8, and 10 years were 83.5%, 78.5%, 70%, and 67.5%, respectively.

Conclusions: A VSR-to-surgery interval of ≥ 8 days and preoperative opened IRA are critical factors influencing postoperative mortality. Surgery performed on or after day 8 following VSR was associated with lower mortality, and preoperative opened IRA may facilitate patient survival until the optimal surgical window.