OBJECTIVES: We reviewed our results and experience over a 14-year period to identify predictors of outcome following surgical repair of postinfarction ventricular septal rupture. METHODS: A retrospective review was carried over a 14-year period. All patients had surgical repair of a postinfarction ventricular septal rupture. Patient demographics, perioperative variables, and survival data were collected. Logistic regression identified independent predictors of 30-day mortality. Multivariate analysis determined the effects of independent risk factors on survival. RESULTS: Surgery for postinfarction ventricular septal rupture was carried out on 59 patients. The median age was 69 years, and 69 were male. In 54 of patients, the ventricular septal rupture was anterior, and 75 had concomitant coronary artery bypass grafting. Mortality was 39 at 30 days. Age was the most important predictor of 30-day and long-term outcome. Logistic regression analysis identified age, preoperative ventilation, and female sex as significant predictors of 30-day mortality. Cardiogenic shock, preoperative ventilation, and advanced age were associated with reduced medium-term survival. Surprisingly, anterior ventricular septal rupture was associated with reduced long-term survival. Concomitant coronary artery bypass grafting did not influence 30-day or long-term outcome. CONCLUSIONS: Despite advances, the surgical mortality from ventricular septal rupture remains high. Age remains the most important predictor of outcome, and concomitant coronary artery bypass grafting does not appear to have a demonstrable benefit. Interestingly, anterior ventricular septal rupture had poorer long-term outcome than inferior ventricular septal rupture.