{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T06:10:14Z","timestamp":1756447814214,"version":"3.44.0"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Post-infarction ventricular septal defect (VSD) repair is in general performed on a cardioplegic heart. An alternative concept is VSD repair on a beating heart. Aim of the study was to identify possible differences in survival between the two strategies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study was a retrospective, observational, single-centre cohort study of data from all patients who underwent post-infarction VSD repair at our institution between May 2012 and December 2022. VSD repair was performed either on an arrested heart with aortic cross-clamping [<jats:italic>n<\/jats:italic>\u2009=\u200928 (<jats:italic>conventional subgroup<\/jats:italic>)] or on a beating-heart [<jats:italic>n<\/jats:italic>\u2009=\u200918 (<jats:italic>beating-heart subgroup<\/jats:italic>)] using CPB without aortic cross-clamping. Primary end-point was survival at 1 year after surgery. Secondary endpoints included the analysis of perioperative variables, 30-day mortality and long-term survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty six consecutive patients underwent repair of post-infarction VSD (28 in the \u201c<jats:italic>conventional subgroup\u201d<\/jats:italic> and 18 in the \u201c<jats:italic>beating-heart subgroup<\/jats:italic>\u201d). The mean age of the patients was 66.4\u2009\u00b1\u200911.2 years and 63% were men. All-cause mortality during the first postoperative 30-days occurred in 12 of 28 patients (43%) in the \u201c<jats:italic>conventional subgroup<\/jats:italic>\u201d and in 4 of 18 patients (22%) in the \u201c<jats:italic>beating-heart subgroup<\/jats:italic>\u201d). Survival at one and five years was 34% and 27% for the \u201c<jats:italic>conventional subgroup<\/jats:italic>\u201d, compared to 72% and 61% for the \u201c<jats:italic>beating-heart subgroup<\/jats:italic>\u201d, respectively [hazard ratio, 2.3; 95% confidence interval (CI), 1.1\u20134.8; <jats:italic>P<\/jats:italic>\u2009=\u20090.0364].<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The modified surgical approach performing VSD-repair on a beating heart was associated with a lower risk of postoperative death than the conventional surgical strategy.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1590588","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T05:45:22Z","timestamp":1756446322000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Post-infarction ventricular septal defect repair: cardioplegic arrest vs. on-pump beating-heart 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