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

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

doi:10.1016/j.jcin.2021.02.046

Cited by 61 publications

(79 citation statements)

References 35 publications

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“…It demonstrated no survival benefit in patients with revascularization. In addition, PCI was found only in the non-survivors indicating an increased mortality association [ 13 ]. Our study confirms better survival with early reperfusion, supporting the results of GUSTO-I and GRACE trials [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

One-year outcome and survival analysis of deferred ventricular septal repair in cardiogenic shock supported with mechanical circulatory support

et al. 2021

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Background and objective The effectiveness of deferred surgical repair of ventricular septal rupture (VSR) post-myocardial infarction (MI) with cardiogenic shock remains limited to case reports. Our study aimed to investigate the outcomes and survival analysis following mechanical circulatory support (MCS) in patients after VSR who develop cardiogenic shock. Methods We analyzed 27 patients with post-MI VSR and cardiogenic shock who received deferred surgical repair while stabilized on MCS between January 2018 and March 2020. After normality test adjustments, continuous variables were expressed as mean ± standard deviation (SD). These were compared using the Mann-Whitney U test and Student’s t-test. Categorical variables were compared using chi-square or Fisher’s exact test. To identify predictors of operative mortality, univariate analysis of clinical characteristics and interventions followed by logistic regression was carried out. P-value of < 0.05 was considered significant. Results All patients had preoperative MCS. Emergency repair was avoided in all the patients. The mean age of the participants was 64.96 with the majority being males (74.1%). On average, the mean time from MI to VSR repair was 18.85 days. Delayed revascularization was associated with increased mortality (OR 17.500, 95% CI 2.365–129.506, P = 0.005). Other factors associated with increased mortality were ejection fraction (EF), three-vessel disease, Killip class, early surgery, and prolonged use of inotropes. The operative mortality was 11% with an overall mortality of 33.3%. The one-year survival rate was 66.7%. Conclusion The use of MCS in adjunct to a deferred surgical approach shows an improved survival outcome of patients with VSR complicated by cardiogenic shock. Further investigations are required regarding the optimal time for MCS and surgical repair.

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Section: Discussionmentioning

confidence: 99%

One-year outcome and survival analysis of deferred ventricular septal repair in cardiogenic shock supported with mechanical circulatory support

et al. 2021

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“… 1 , 12 , 16 , 24 Moreover, it is noteworthy that 8.3% of deaths were intraoperative, indicating that improvements are needed in the management protocols of these patients. 35 Indeed, as presented in the eFigure in the Supplement , the temporal trend of early mortality for surgically treated VSR remained high and unchanged over the last 2 decades, despite surgical and technological advancements. 3 , 24 Most of the patients died due to LCOS or multiorgan failure, highlighting the severe effects of this condition on biventricular function, despite proper repair.…”

Section: Discussionmentioning

confidence: 99%

“… 6 , 7 , 26 , 29 , 31 , 32 , 33 Indeed, preoperative MCS adoption is sometimes discouraged by the potential interactions of MCS- and VSR-related pathophysiology, which can be anticipated and carefully managed with a patient-tailored, preimplantation analysis. 7 , 34 , 35 …”

Section: Discussionmentioning

confidence: 99%

“…Similar to other reports, we found that the time from VSR occurrence to surgery was significantly shorter for patients who died, reinforcing the association between early intervention and higher mortality and potentially highlighting the need for a paradigm shift in the management of patients with VSR ( Figure 1 B). 6 , 15 , 26 , 29 , 30 , 31 , 35 Timing from AMI to VSR and from VSR to surgery were not included in the multivariate analysis because approximately 30% of patients were missing these data; therefore, we could not perform further between-group comparisons. However, it is reasonable to suppose that the evidence provided by such a difference is strong enough to represent a significant result.…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 16 However, broader prophylactic MCS adoption for patients with impaired ventricular function might improve outcomes, as described in various reports, with encouraging results. 7 , 26 , 29 , 35 , 36 Nevertheless, further studies are required to examine the potential effects of MCS in both preoperative and postoperative periods on outcomes as well as their impact on overall postinfarct VSR management, including the timing of surgery.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Treatment of Postinfarction Ventricular Septal Rupture

et al. 2021

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IMPORTANCE Ventricular septal rupture (VSR) is a rare but life-threatening mechanical complication of acute myocardial infarction associated with high mortality despite prompt treatment. Surgery represents the standard of care; however, only small single-center series or national registries are usually available in literature, whereas international multicenter investigations have been poorly carried out, therefore limiting the evidence on this topic. OBJECTIVESTo assess the clinical characteristics and early outcomes for patients who received surgery for postinfarction VSR and to identify factors independently associated with mortality. DESIGN, SETTING, AND PARTICIPANTS The Mechanical Complications of Acute Myocardial Infarction: an International Multicenter Cohort (CAUTION) Study is a retrospective multicenter international cohort study that includes patients who were treated surgically for mechanical complications of acute myocardial infarction. The study was conducted from January 2001 to December 2019 at 26 different centers worldwide among 475 consecutive patients who underwent surgery for postinfarction VSR. EXPOSURES Surgical treatment of postinfarction VSR, independent of the technique, alone or combined with other procedures (eg, coronary artery bypass grafting). MAIN OUTCOMES AND MEASURESThe primary outcome was early mortality; secondary outcomes were postoperative complications. RESULTSOf the 475 patients included in the study, 290 (61.1%) were men, with a mean (SD) age of 68.5 (10.1) years. Cardiogenic shock was present in 213 patients (44.8%). Emergent or salvage surgery was performed in 212 cases (44.6%). The early mortality rate was 40.4% (192 patients), and it did not improve during the nearly 20 years considered for the study (median [IQR] yearly mortality, 41.7% [32.6%-50.0%]). Low cardiac output syndrome and multiorgan failure were the most common causes of death (low cardiac output syndrome, 70 [36.5%]; multiorgan failure, 53 [27.6%]). Recurrent VSR occurred in 59 participants (12.4%) but was not associated with mortality. Cardiogenic shock (survived: 95 [33.6%]; died, 118 [61.5%]; P < .001) and early surgery (time to surgery Ն7 days, survived: 105 [57.4%]; died, 47 [35.1%]; P < .001) were associated with lower survival. At multivariate analysis, older age (odds ratio [

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Strategies for Advanced Mechanical Circulatory Support in Refractory Cardiogenic Shock

Cannata

Carrozzini

Costetti

et al. 2023

The High-Risk Surgical Patient

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

Cited by 61 publications

References 35 publications

One-year outcome and survival analysis of deferred ventricular septal repair in cardiogenic shock supported with mechanical circulatory support

One-year outcome and survival analysis of deferred ventricular septal repair in cardiogenic shock supported with mechanical circulatory support

Surgical Treatment of Postinfarction Ventricular Septal Rupture

Strategies for Advanced Mechanical Circulatory Support in Refractory Cardiogenic Shock

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