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

Author information

Affiliations

  • 1. Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy.
      Authors
    • Ronco D 1
    • Matteucci M 1
    • Torchio F 1
    • Corazzari C 1
    • Massimi G 1
    (5 authors)
  • 2. Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.
      Authors
    • Ravaux JM 2
    • Maessen J 2
    (2 authors)
  • 3. Humanitas Clinical and Research Center-IRCCS, Scientific Documentation Center, Rozzano, Milan, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy.
      Authors
    • Marra S 3
    (1 author)
  • 4. Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy.
      Authors
    • Beghi C 4
    (1 author)
  • 5. Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
      Authors
    • Lorusso R 5
    (1 author)

ORCIDs linked to this article

JACC. Cardiovascular Interventions, 01 May 2021, 14(10):1053-1066
https://doi.org/10.1016/j.jcin.2021.02.046 PMID: 34016403 

Review

A comment on this article appears in "Temporary Mechanical Circulatory Support in Postinfarct Ventricular Septal Defect: Time for an Upgrade?" JACC Cardiovasc Interv. 2021 Sep 13;14(17):1955. A comment on this article appears in "Reply: Temporary Mechanical Circulatory Support in Postinfarct Ventricular Septal Defect: Time for an Upgrade?" JACC Cardiovasc Interv. 2021 Sep 13;14(17):1955.

Abstract 

Ventricular septal rupture (VSR) represents a rare complication of acute myocardial infarction, often presenting with cardiogenic shock and associated with high in-hospital mortality despite prompt intervention. Although immediate surgery is recommended for patients who cannot be effectively stabilized, the ideal timing of intervention remains controversial. Mechanical circulatory support (MCS) may allow hemodynamic stabilization and delay definitive treatment even in critical patients. However, the interactions between MCS and VSR pathophysiology as well as potentially related adverse effects remain unclear. A systematic review was performed, from 2000 onward, to identify reports describing MCS types, effects, complications, and outcomes in the pre-operative VSR-related setting. One hundred eleven studies (2,440 patients) were included. Most patients had well-known negative predictors (e.g., cardiogenic shock, inferior infarction). Almost all patients had intra-aortic balloon pumps, with additional MCS adopted in 129 patients (77.5% being venoarterial extracorporeal membrane oxygenation). Mean MCS bridging time was 6 days (range: 0 to 23 days). In-hospital mortality was 50.4%, with the lowest mortality rate in the extracorporeal membrane oxygenation group (29.2%). MCS may enhance hemodynamic stabilization and delayed VSR treatment. However, the actual effects and interaction of the MCS-VSR association should be carefully assessed to avoid further complications or incorrect MCS-VSR coupling.

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Read article at publisher's site: https://doi.org/10.1016/j.jcin.2021.02.046

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