Extracorporeal membrane oxygenation before surgical repair of a postinfarction ventricular septal defect

Moran, Hellmuth R. Muller; Dutta, Vikas; Yan, Weiang; Ghorpade, Nitin; Arora, Rakesh C.; Singal, Rohit K.; Strumpher, Johann

doi:10.1016/j.jtcvs.2017.11.083

Cited by 5 publications

(3 citation statements)

References 5 publications

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“…These conditions may result in systemic muscular depression, a worsened respiratory condition, increased susceptibility to infection, haemodynamic collapse, and significant major organ dysfunctions, all resulting in poor postoperative outcomes. Although an ECMO bridge to VSD repair may be a useful treatment in selected patients, 13 its efficacy remains unknown. Successful emergency VSD repair allows us to eliminate complications associated with delays in surgery.…”

Section: Discussionmentioning

confidence: 99%

Emergency sandwich patch repair via right ventricular incision for postinfarction ventricular septal defects: a case series

Shimahara

Fukushima

Yajima

et al. 2021

European Heart Journal - Case Reports

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Background The surgical treatment for postinfarction ventricular septal defect (VSD) remains challenging, especially in emergency cases. Several authors have reported the efficacy of a sandwich patch VSD repair via a right ventricular (RV) incision. However, this procedure remains uncommon, and its efficacy is still unknown, especially when performed under an emergency. Case summary We were able to perform sandwich patch VSD repair via an RV incision on seven consecutive patients with VSD following an ST-segment elevation myocardial infarction (STEMI) from March 2017 to December 2019. Bovine pericardial patches were used for sandwich patches. Two patients developed inferior STEMI, and the other patients developed anterior STEMI. Six patients received intra-aortic balloon pump prior to surgery, and the other received extracorporeal membrane oxygenation with Impella. The interval between the diagnosis of VSD and surgery was within 1 day in all patients except one (5 days). All seven patients underwent VSD repair in the emergency status. Four patients underwent concomitant coronary artery bypass grafting. The hospital mortality rate was 14.3% (1/7). Early postoperative transthoracic echocardiography revealed that only one patient developed more than trace residual shunt. The postoperative right atrial pressure was not significantly elevated at ≤12 mmHg in all patients. No patient developed early postoperative prolonged low cardiac output syndrome. Discussion In patients with postinfarction VSD, a sandwich patch VSD repair via an RV incision is a promising procedure with a low incidence of residual shunt development and hospital mortality, even in emergency cases.

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Section: Discussionmentioning

confidence: 99%

Emergency sandwich patch repair via right ventricular incision for postinfarction ventricular septal defects: a case series

Shimahara

Fukushima

Yajima

et al. 2021

European Heart Journal - Case Reports

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“…However, this method cannot always prevent circulatory collapse in some patients in critical conditions. Recent studies and reviews have suggested the adoption of more aggressive mechanical circulatory support devices, such as ECMO, in order to reach hemodynamic stabilization (even cardiogenic shock reversal) and possibly delayed surgery for unstable patients (16)(17)(18)(19). We had limited experience with ECMO in two VSR cases.…”

Section: All-cause Death (N = 9)mentioning

confidence: 99%

Survival and risk factors associated with surgical repair of ventricular septal rupture after acute myocardial infarction: A single-center experience

Zhao

Sun

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveTo analyze the survival and risk factors associated with the surgical treatment of ventricular septal rupture (VSR) after acute myocardial infarction (AMI).MethodsWe retrospectively analyzed 45 consecutive patients with VSR after AMI whose procedures were performed in the Department of Cardiovascular Surgery at the General Hospital of Northern Theater Command between January 2012 and December 2021. Relevant clinical data, surgery-related conditions, and follow-up data of all patients were summarized. Patients were divided into the survival group and the death group. The Kaplan–Meier method and log-rank test were used to determine the cumulative incidence of all-cause mortality. Multivariate logistic regression was used to evaluate the independent risk factors for all-cause mortality.ResultsThe average postoperative follow-up time was 42.1 ± 34.1 months. The overall mortality rate was 20% (9/45 patients) and the operative mortality rate was 8.9% (4/45 patients). Logistic analysis showed that the death group had higher serum creatinine (127.32 ± 47.82 vs. 82.61 ± 27.80 μmol/L, respectively; P = 0.0238) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) [8,654.00 pg/mL (6,197.00–11,949.00 pg/mL) vs. 4,268.96 pg/mL (1,800.00–7,894.00 pg/mL), respectively; P = 0.0134] levels than the survival group. The cardiopulmonary bypass time (CPB) was longer in the death group than in the survival group [131.00 min (121.00–184.00 min) vs. 119.00 min (103.00–151.50 min), respectively; P = 0.0454]. Significantly more red blood cells were transfused in the death group than in the survival group [11.60 units (6.10–16.50) vs. 3.75 units (0.00–7.00 units), respectively; P = 0.0025]. Intra-aortic balloon pump (IABP) implantation (P = 0.016) and ventilation time (P = 0.0022) were risk factors for mortality. A 1-month landmark analysis showed that compared with patients with VSR to surgical time >14 days, patients who underwent surgery within 14 days had a higher rate of all-cause mortality (25.00 vs. 3.33%; log-rank P = 0.023). Patients with VSR within 14 days also had a higher rate of residual shunts that were higher than moderate. Multivariate analysis showed that transfusion of red blood cells and NT-proBNP level were risk factors for all-cause mortality, as well as major adverse cardiovascular and cerebrovascular events.ConclusionsSurgical repair resulted in good outcomes for patients with VSR after AMI. Patients with VSR to surgical time >14 days had a lower rate of all-cause mortality. Treatment strategies for VSR should be based on the patient's condition and comprehensively determined through real-time evaluation and monitoring.

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“…Two patients supported only with ECMO for 4 to 7 days then underwent repair, and both survived. The case report in this issue of the Journal by Muller Moran and colleagues 6 describes a patient with PI-VSD who had deterioration with severe cardiogenic shock and recovered remarkably well with ECMO support for 9 days before operative repair. This patient did require another 6 days of ECMO support before decannulation was done, but he then did well and finally recovered, albeit after a long hospitalization.…”

Section: Vincent R Conti MDmentioning

confidence: 99%

Extracorporeal membrane oxygenation for recovery, then elective surgical repair

Conti

2018

The Journal of Thoracic and Cardiovascular Surgery

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Extracorporeal membrane oxygenation before surgical repair of a postinfarction ventricular septal defect

Abstract: Massive PI-VSD as visualized by echocardiography. Central Message Extracorporeal membrane oxygenation may be a viable rescue strategy for patients presenting in cardiogenic shock from large PI-VSDs before surgical repair.

Cited by 5 publications

References 5 publications

Emergency sandwich patch repair via right ventricular incision for postinfarction ventricular septal defects: a case series

Emergency sandwich patch repair via right ventricular incision for postinfarction ventricular septal defects: a case series

Survival and risk factors associated with surgical repair of ventricular septal rupture after acute myocardial infarction: A single-center experience

Extracorporeal membrane oxygenation for recovery, then elective surgical repair

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