Preoperative Impella therapy in patients with ventricular septal rupture and cardiogenic shock: haemodynamic and organ function outcomes

Abstract

OBJECTIVES We examined the effects of preoperative Impella treatment on haemodynamic stability, organ recovery, and postoperative outcomes in patients with postinfarction ventricular septal rupture and cardiogenic shock. METHODS Between April 2018 and February 2024, the data of 10 of 15 patients with postinfarction ventricular septal rupture and cardiogenic shock who underwent Impella therapy were analyzed. Urgent surgery was contingent on haemodynamic stability with Impella/ECpella, except in the presence of organ failure. We utilized a generalized linear mixed model to evaluate organ ischaemia through changes in blood parameters upon admission and at subsequent intervals post-Impella insertion. RESULTS Preoperative Impella or combined Impella and ECpella (five patients each) support were provided, with diagnoses and surgeries occurring at an average of 4 days (interquartile range: 2–5) and 8 days (interquartile range: 2–14) after myocardial infarction, respectively. Treatment significantly reduced lactate, alanine aminotransferase, creatine kinase-MB, and troponin I levels (p ≤ 0.05 for all). Conversely, no significant change was noted in the aspartate aminotransferase level or estimated glomerular filtration rate. Hemoglobin and platelet counts decreased despite transfusions (p < 0.001). No surgical deaths occurred; however, 70% of the patients required prolonged mechanical ventilation and 80% were transferred for rehabilitation. CONCLUSIONS Impella or ECpella treatment can improve haemodynamic and organ failure outcomes in postinfarction ventricular septal rupture and cardiogenic shock. However, the risks of prolonged support, including hemorrhagic events and the need for extended rehabilitation, point to a need for comparative studies to optimize support duration.