Cor Vasa 2025, 67(6):677-685

Surgical Repair of Post-Infarction Ventricular Septal Rupture with or without Concomitant Coronary Artery Bypass Grafting: A Systematic Review and Meta-Analysis of Outcomes and Prognostic Implications

Ery Irawan^{a, b}, Yan Efrata Sembiring^{a, b}

^a Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Airlangga University, Surabaya, Indonesia

^b Department of Thoracic, Cardiac and Vascular Surgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

Introduction: Post-myocardial infarction ventricular septal rupture (VSR) is a rare but fatal complication that requires urgent surgical repair. The benefit of adding concomitant coronary artery bypass grafting (CABG) remains controversial. While CABG may protect viable myocardium in patients with coronary artery disease, it also increases operative complexity and ischemic time. This review evaluates the prognostic impact of concomitant CABG during VSR repair.

Methods: A systematic literature search was conducted in PubMed, ScienceDirect, BMC, and Springer databases according to PRISMA guidelines. Studies reporting surgical VSR repair with and without CABG were included. The primary endpoint was survival, analysed through meta-analysis, and prognostic variables were also reviewed.

Results: Twelve retrospective studies involving 2,050 patients were identified, including 857 who underwent concomitant CABG and 1,193 who had isolated VSR repair. Baseline demographics were broadly comparable, although CABG patients more frequently presented with multivessel disease. Patch closure was the predominant repair technique. CABG was associated with longer cross-clamp times but not with higher perioperative complications. Survival events occurred in 547/857 (63.8%) of CABG patients versus 780/1,193 (65.4%) without CABG. The pooled odds ratio for survival was 1.02 (95% CI, 0.84-1.24; p = 0.83), with negligible heterogeneity (I² = 0%). These findings suggest concomitant CABG can be performed safely, with potential value in patients with complex coronary disease, although increased operative time may pose risk in elderly or unstable individuals.

Conclusion: Concomitant CABG during VSR repair does not provide a universal survival advantage but remains a safe option, particularly for patients with multivessel disease. Surgical decisions should be individualized, and further prospective studies are needed to refine treatment strategies.

Keywords: Cardiac surgery, Coronary artery bypass grafting, Post-myocardial infarction, Ventricular septal rupture

Received: September 21, 2025; Revised: September 21, 2025; Accepted: October 13, 2025; Prepublished online: June 2, 2012; Published: December 15, 2025  Show citation