BACKGROUND: Current guidelines recommend emergency surgical correction in patients with post infarction ventricular septal rupture (PIVSR), but patients with multiorgan failure are commonly managed conservatively because of high surgical risk. We assessed characteristics and outcomes of operated PIVSR patients with or without the use of short-term ventricular assist devices (ST-VADs). We also assessed the impact of a ST-VAD on the performance of surgery. METHODS: We retrospectively analysed all consecutive patients with PIVSR between January 2004 and May 2017. Baseline clinical characteristics, use of ST-VAD and performance of surgery during admission were assessed. The main outcome measured was in-hospital mortality. RESULTS: A total of 28 patients were included. Mean age was 69.2 years. Most patients (20/28, 71.4%) underwent surgical repair. ST-VADs were used in 11/28 patients (39.3%). This percentage progressively increased across the study period, from 22.2% (2/9) in 2004-2011 to 58.3% (7/12) in 2015-2017 (p=0.091). Patients undergoing ST-VAD use had poorer INTERMACS status, higher values of creatinine, lactate and alanine aminotransferase and lower left ventricular ejection fraction as compared with operated patients without support. In-hospital mortality did not differ according to the use of ST-VADs in operated patients (27.3% without ST-VAD vs. 22.2% with ST-VAD, p=0.604). All five patients undergoing early preoperative venoarterial extracorporeal membrane oxygenator support and delayed surgery survived at hospital discharge. CONCLUSIONS: ST-VAD use increased in patients with PIVSR. Despite a higher risk profile in operated patients undergoing ST-VAD use, mortality was not significantly different in these patients. Early preoperative venoarterial extracorporeal membrane oxygenation should be considered for very high risk PIVSR patients.
BACKGROUND: Current guidelines recommend emergency surgical correction in patients with post infarction ventricular septal rupture (PIVSR), but patients with multiorgan failure are commonly managed conservatively because of high surgical risk. We assessed characteristics and outcomes of operated PIVSR patients with or without the use of short-term ventricular assist devices (ST-VADs). We also assessed the impact of a ST-VAD on the performance of surgery. METHODS: We retrospectively analysed all consecutive patients with PIVSR between January 2004 and May 2017. Baseline clinical characteristics, use of ST-VAD and performance of surgery during admission were assessed. The main outcome measured was in-hospital mortality. RESULTS: A total of 28 patients were included. Mean age was 69.2 years. Most patients (20/28, 71.4%) underwent surgical repair. ST-VADs were used in 11/28 patients (39.3%). This percentage progressively increased across the study period, from 22.2% (2/9) in 2004-2011 to 58.3% (7/12) in 2015-2017 (p=0.091). Patients undergoing ST-VAD use had poorer INTERMACS status, higher values of creatinine, lactate and alanine aminotransferase and lower left ventricular ejection fraction as compared with operated patients without support. In-hospital mortality did not differ according to the use of ST-VADs in operated patients (27.3% without ST-VAD vs. 22.2% with ST-VAD, p=0.604). All five patients undergoing early preoperative venoarterial extracorporeal membrane oxygenator support and delayed surgery survived at hospital discharge. CONCLUSIONS: ST-VAD use increased in patients with PIVSR. Despite a higher risk profile in operated patients undergoing ST-VAD use, mortality was not significantly different in these patients. Early preoperative venoarterial extracorporeal membrane oxygenation should be considered for very high risk PIVSR patients.
Authors: Daniele Ronco; Matteo Matteucci; Mariusz Kowalewski; Michele De Bonis; Francesco Formica; Federica Jiritano; Dario Fina; Thierry Folliguet; Nikolaos Bonaros; Claudio Francesco Russo; Sandro Sponga; Igor Vendramin; Carlo De Vincentiis; Marco Ranucci; Piotr Suwalski; Giosuè Falcetta; Theodor Fischlein; Giovanni Troise; Emmanuel Villa; Guglielmo Actis Dato; Massimiliano Carrozzini; Giuseppe Filiberto Serraino; Shabir Hussain Shah; Roberto Scrofani; Antonio Fiore; Jurij Matija Kalisnik; Stefano D'Alessandro; Vittoria Lodo; Adam R Kowalówka; Marek A Deja; Salman Almobayedh; Giulio Massimi; Matthias Thielmann; Bart Meyns; Fareed A Khouqeer; Nawwar Al-Attar; Matteo Pozzi; Jean-François Obadia; Udo Boeken; Nikolaos Kalampokas; Carlo Fino; Caterina Simon; Shiho Naito; Cesare Beghi; Roberto Lorusso Journal: JAMA Netw Open Date: 2021-10-01
Authors: Juan Diego Sánchez Vega; Gonzalo Luis Alonso Salinas; José María Viéitez Florez; Albert Ariza Solé; Esteban López de Sá; Ricardo Sanz-Ruiz; Virginia Burgos Palacios; Sergio Raposeiras Roubin; Susana Gómez Varela; Juan Sanchís Forés; Lorenzo Silva Melchor; Xurxo Martínez-Seara; Lorena Malagón López; Ana Viana Tejedor; Miguel Corbí Pascual; José Luis Zamorano Gómez; Marcelo Sanmartín-Fernández Journal: Cardiol J Date: 2022-05-17 Impact factor: 3.487
Authors: Abdulla A Damluji; Sean van Diepen; Jason N Katz; Venu Menon; Jacqueline E Tamis-Holland; Marie Bakitas; Mauricio G Cohen; Leora B Balsam; Joanna Chikwe Journal: Circulation Date: 2021-06-15 Impact factor: 39.918