Mechanical Circulatory Support as a Bridge to Definitive Treatment in Post-Infarction Ventricular Septal Rupture

Daniele Ronco*, Matteo Matteucci, Justine M. Ravaux, Silvia Marra, Federica Torchio, Claudio Corazzari, Giulio Massimi, Cesare Beghi, Jos Maessen, Roberto Lorusso

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

15 Citations (Web of Science)

Abstract

Ventricular septal rupture (VSR) represents a rare complication of acute myocardial infarction, often presenting with cardiogenic shock and associated with high in-hospital mortality despite prompt intervention. Although immediate surgery is recommended for patients who cannot be effectively stabilized, the ideal timing of intervention remains controversial. Mechanical circulatory support (MCS) may allow hemodynamic stabilization and delay definitive treatment even in critical patients. However, the interactions between MCS and VSR pathophysiology as well as potentially related adverse effects remain unclear. A systematic review was performed, from 2000 onward, to identify reports describing MCS types, effects, complications, and outcomes in the pre-operative VSR-related setting. One hundred eleven studies (2,440 patients) were included. Most patients had well-known negative predictors (e.g., cardiogenic shock, inferior infarction). Almost all patients had intra-aortic balloon pumps, with additional MCS adopted in 129 patients (77.5% being venoarterial extracorporeal membrane oxygenation). Mean MCS bridging time was 6 days (range: 0 to 23 days). Inhospital mortality was 50.4%, with the lowest mortality rate in the extracorporeal membrane oxygenation group (29.2%). MCS may enhance hemodynamic stabilization and delayed VSR treatment. However, the actual effects and interaction of the MCS-VSR association should be carefully assessed to avoid further complications or incorrect MCS-VSR coupling. (C) 2021 by the American College of Cardiology Foundation.

Original languageEnglish
Pages (from-to)1053-1066
Number of pages14
JournalJacc-Cardiovascular Interventions
Volume14
Issue number10
DOIs
Publication statusPublished - 24 May 2021

Keywords

  • extracorporeal life support
  • heart rupture
  • mechanical circulatory support
  • myocardial infarction
  • ventricular septal rupture
  • EXTRACORPOREAL MEMBRANE-OXYGENATION
  • ACUTE MYOCARDIAL-INFARCTION
  • TOTAL ARTIFICIAL-HEART
  • ASSIST DEVICE
  • SURGICAL REPAIR
  • CARDIOGENIC-SHOCK
  • DEFECT
  • MANAGEMENT
  • OUTCOMES
  • SURGERY

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