Techniques, Timing, and Prognosis of Transcatheter Post Myocardial Infarction Ventricular Septal Defect Repair

Faccini, Alessia; Butera, Gianfranco

doi:10.1007/s11886-019-1142-8

Cited by 14 publications

(13 citation statements)

References 36 publications

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“…Access is usually obtained from the femoral artery and femoral (anterior post infarct VSD) or jugular vein (inferobasal postinfarct VSD). Choice of access site and initial approach are dictated by patient considerations including the presence of MCS such as Impella, VA-ECMO and IABP and location of the defect 35. Some operators choose to use the radial artery rather than the femoral to reduce bleeding risk.…”

Section: Undertaking the Proceduresmentioning

confidence: 99%

Transcatheter treatment of postinfarct ventricular septal defects

Giblett

Jenkins

Calvert

2020

Heart

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Postinfarct ventricular septal defects (VSDs) are a mechanical complication of acute myocardial infarction (AMI) with a very poor prognosis. They are estimated to occur in 0.2% of patients presenting with AMI, with 1-month survival of 6% without intervention. Guidelines recommend surgical repair, but recent advances in transcatheter technology, and bespoke device development, mean it is increasingly viable as a closure option. Surgical mortality is between 30% and 50% for all-comers, while in series of transcatheter closure, mortality was 32%. Transcatheter closure appears durable, with no evidence of late leaks and low long-term mortality in series with up to 5-year follow-up. Guidelines recommend early closure, which is likely to provide most benefit for patients regardless of the closure method. Multimodality cardiac imaging including echocardiography, CT and cardiac MRI can define size, shape, location of defects and their relationship to other cardiac structures, assisting with treatment decisions. Brief delay to allow stabilisation of the patient is appropriate, but untreated patients risk rapid deterioration. Mechanical circulatory support may be helpful, although the preferred modality is unclear. Transcatheter closure involves large bore venous access and the formation of an arteriovenous loop (under fluoroscopic and trans-oesophageal echocardiographic guidance) in order to facilitate deployment of the device in the defect and close the postinfarct VSD. Guidelines suggest transcatheter closure as an alternative to surgical repair in centres where appropriate expertise exists, but decisions for all patients with postinfarct VSD should be led by the multidisciplinary heart team.

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Section: Undertaking the Proceduresmentioning

confidence: 99%

Transcatheter treatment of postinfarct ventricular septal defects

Giblett

Jenkins

Calvert

2020

Heart

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“…The patient had already completed reperfusion therapy and was under DAPT, thus transcatheter closure is an effective option in the timing of stable hemodynamics [ 26 , 27 ], but the DAPT is not a contraindication of surgical repair. Surgical repair was once considered but abandoned because of a higher risk of general anesthesia, extracorporeal circulation support, and bleeding when DAPT was adopted.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter closure of ventricular septal rupture with prolonged support of intra-aortic balloon pump after primary PCI: a case report

Yang

Sun

Zou

et al. 2021

BMC Cardiovasc Disord

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Background Ventricular septal rupture (VSR) is a rare but severe complication of acute myocardial infarction (AMI). For such cases, surgical repair is recommended by major guidelines, but not always possible for such cases. Case presentation A 72-year-old man presented to the emergency room. ECG showed the ST-segment was elevated by 2–3 mm in lead II, III, and aVF, with Q-waves. Coronary angiography (CAG) showed multi-vessel disease with a total occlusion of the right coronary artery (RCA) and severe stenosis of the left anterior descending artery (LAD). A diagnosis of acute inferior myocardial infarction was made. VSR occurred immediately after percutaneous coronary intervention (a 2.5 × 20 mm drug-eluting stent implanted in RCA), and the patient developed cardiogenic shock. An intra-aortic balloon pump (IABP) was used to stabilize the hemodynamics. Transthoracic echocardiography (TTE) revealed an 11.4-mm left-to-right shunt in the interventricular septum. An attempt was made to reduce the IABP augmentation ratio for weaning on day 12 but failed. Transcatheter closure was conducted using a 24-mm double-umbrella occluder on day 28. The patient was weaned from IABP on day 31 and underwent secondary PCI for LAD lesions on day 35. The patient was discharged on day 41. Upon the last follow-up 6 years later, CAG and TTE revealed no in-stent restenosis, no left-to-right shunt, and 51% left ventricular ejection fraction. Conclusions Prolonged implementation of IABP can be a viable option to allow deferred closure of VSR in AMI patients, and transcatheter closure may be considered as a second choice for the selected senior and vulnerable patients, but the risk is still high.

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“…In the Gusto‐I trial, mortality in surgically treated patients with MI‐VSD was 47% overall, 87% with cardiogenic shock and 94% in medically treated patients 10 . Because surgical repair in the acute phase has been shown to be associated with heightened morbidity and mortality compared to repair in the chronic phase, some advocate for a watchful waiting approach for the first few weeks post‐MI, particularly in the absence of cardiogenic shock 11 . When cardiogenic shock is present, especially when defect size is large (≥15 mm), there is some consensus in the surgical community that early surgical repair is favored 12,13 .…”

Section: Discussionmentioning

confidence: 99%