4.3 Factors affecting TCC outcomes for PIVSD
Cardiogenic shock(CS) is a terrible complication of PIVSD accompanied by
the high mortality rate is approximately 89%[2].
Our data suggest that patients who developed VSD and died were the more
likely to the occurrence of CS before TCC. Accompanied by catastrophic
mortality (about 87%) and reduced progression on patients with CS also
in the SHOCK trial[1]. Similarly, majorities
studies have confirmed the same
conclusion[10,15,18,32]. In high surgical-risk
patients with PIVSD, NYHA class IV and a long time from VSD to
transcatheter are also correlated with high mortality,while the defect
size and have no relevance to the mortality. There may be a variety of
mechanisms for these results.
On the one hand, When NYHA class IV indicates the patients with a
terrible clinical state, they need the support of inotropes or IABP,
even the surgical repair promptly. Now keeping the stability of the
hemodynamics is a critical therapeutic strategy at an early stage of
PIVSD. On the other hand, and it is hard to find available occlude
devices and lack of firm tissue to seat the device for large defect
sizes. Unpaired occluder will generate resident shunt and long-term
residual shunt can lead to infective endocarditis and even left
ventricular rupture [33,34]. Moreover, in their
studies, Shi Tai et al. Calvert et al. found that advanced age and
female sex are risk factors for PIVSD patients. The following
explanation about why women with increased risk of VSD is given by
Andrew: “Contributing factors may include women’s older age at
presentation, greater comorbidities, frequency of atypical symptoms
leading to treatment delay, and decreased likelihood of treatment with
guideline-driven medical and reperfusion
therapies[35,36] ”.