Delayed Repair of Ventricular Septal Rupture Following Preoperative Awake Extracorporeal Membrane Oxygenation Support

Abstract

Outcomes of ventricular septal rupture (VSR) as a complication of acute myocardial infarction are extremely poor, with an in-hospital mortality rate of 45% in surgically treated patients and 90% in patients managed with medication. Delaying surgery for VSR is a strategy for reducing mortality. However, hemodynamic instability is the main problem with this strategy. In the present case, venoarterial extracorporeal membrane oxygenation (ECMO) was used to provide stable hemodynamic support before the delayed surgery. Awake ECMO was also used to avoiding the complications of sedatives and mechanical ventilation. Here, we describe a successful operation using awake ECMO as a bridge to surgery.

The role of perioperative cardiorespiratory support in post infarction ventricular septal rupture-related cardiogenic shock

“…Several authors have suggested a potential role of ST-VAD use in critical patients with PIVSR during recent years. [7][8][9][10][11][12][13][14][15][16][17][18][19][20] Mechanical support may help patients to overcome multiorgan failure and systemic inflammatory response syndrome after a major surgical procedure in unstable conditions. 9,11,13 On the other hand, an early preoperative mechanical support may improve haemodynamic and metabolic status and allow a delayed surgery in a better condition.…”

“…9,11,13 On the other hand, an early preoperative mechanical support may improve haemodynamic and metabolic status and allow a delayed surgery in a better condition. 7,8,10,[14][15][16][18][19][20] This approach was assessed in an interesting paper by Rob et al 20 The authors described a series of 31 consecutive patients with PIVSR, of whom 14 were in cardiogenic shock. Half of these cardiogenic shock patients (7/14) underwent femoral VA-ECMO support at admission in order to optimize haemodynamic status and perform scheduled surgery a few days afterwards.…”

“…6 Some authors have suggested a potential role of ST-VAD in critical patients with PIVSR. [7][8][9][10][11][12][13][14][15][16][17][18][19][20] We aimed to assess the characteristics and outcomes of patients with PIVSR undergoing surgical repair according to the use of ST-VADs. We also aimed to describe the historical trends of use of ST-VADs and surgical repair of PIVSR in consecutive patients from a tertiary care centre.…”

Emergence of Ventricular Septal Rupture During Primary Coronary Intervention for Myocardial Infarction Manifested as Unexpected Coronary Blood Flow Disturbance

“…For the purpose of maintaining a favorable hemodynamic condition until VSR closure, intra-aortic balloon pumping is usually considered as routine care for mechanical afterload reduction and augmentation of the cardiac output. On the other hand, there have been several reports on the use of ECMO systems to stabilize hemodynamics in this situation until surgery, but the effect of this strategy remains controversial [ 6 – 8 ].…”

2020 EACTS/ELSO/STS/AATS Expert Consensus on Post-Cardiotomy Extracorporeal Life Support in Adult Patients

“…ECLS, which provides full cardiorespiratory support during this time period, might protect the patient's circulation while allowing time from infarction to the surgical correction, improving surgical outcomes. 226,227 Experience in this area is still anecdotal, but the usefulness of ECLS in these circumstances, i.e. providing temporary support both preoperatively and postoperatively, to counteract RV/LV dysfunction refractory to pharmacological and IABP treatment, has significant appeal.…”