JOURNAL ARTICLE

Mechanical circulatory support for early surgical repair of post-infarction ventricular septal defect with cardiogenic shock

Maximilian Vondran, Mahmoud S Wehbe, Christian Etz, Tamer Ghazy, Ardawan J Rastan, Michael A Borger, Thomas Schroeter
Artificial Organs 2020 August 28
32857884

BACKGROUND: Post-infarction ventricular septal defect (pVSD) due to acute myocardial infarction complicated by cardiogenic shock (CS) is associated with high mortality. The aim of this study was to determine the outcome of primary surgical repair of pVSD in patients with CS and examine whether it is influenced by the use of mechanical circulatory support (MCS) devices.

METHODS: Between 10/1994 and 04/2016, primary surgical repair of pVSD complicated by CS was performed in 53 patients. Thirty-six (68%) were implanted pre-operatively with an intraaortic balloon pump (IABP), 4 (8%) with extracorporeal life support (ECLS), and 13 (24%) received no MCS device. Prospectively collected demographic and peri-operative data were analyzed retrospectively. All-cause, 30-day mortality rates were analyzed and multivariate analysis was performed to differentiate independent risk factors.

RESULTS: No pre-operatively implanted MCS device was able to improve 30-day survival, whereas pre-operatively implanted ECLS tended to have a positive effect (p=0.106). The post-operative need for a MCS device or escalation of MCS invasiveness (IABP upgrade to ECLS) was associated with a higher 30-day mortality (p=0.001) compared with patients without any MCS device or those with pre-operatively implanted MCS devices. An independent risk factor for 30-day mortality was the interval between acute myocardial infarction and surgery < 7 days (OR 5.895, CI 1.615-21.515; p=0.007).

CONCLUSIONS: Pre-operative implantation of ECLS for CS tends to improve the outcome of early primary surgical pVSD repair. The need for a post-operative MCS device is associated with a worse 30-day survival after early primary surgical pVSD repair.

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