https://doi.org/10.1177/2048872618817485 European Heart Journal: Acute Cardiovascular Care 2020, Vol. 9(2) 128–137 © The European Society of Cardiology 2018 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/2048872618817485 journals.sagepub.com/home/acc The role of perioperative cardiorespiratory support in post infarction ventricular septal rupture- related cardiogenic shock Albert Ariza-Solé 1 , José C Sánchez-Salado 1 , Fabrizio Sbraga 2 , Daniel Ortiz 2 , José González-Costello 3 , Arnau Blasco-Lucas 2 , Oriol Alegre 1 , David Toral 2 , Victòria Lorente 1 , Eva Santafosta 4 , Jacobo Toscano 2 , Andrea Izquierdo 1 , Albert Miralles 2 and Ángel Cequier 1 Abstract 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. Keywords Ventricular septal rupture, myocardial infarction, cardiogenic shock, ventricular assist devices Date received: 15 April 2018; accepted: 15 November 2018 1 Intensive Cardiac Care Unit, Cardiology Department, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain 2 Heart Surgery Department, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain 3 Advanced Heart Failure and Heart Transplant Unit, Cardiology Department, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain 817485ACC European Heart Journal: Acute Cardiovascular CareAriza-Solé et al. Original scientific paper 4 Intensive Care Unit, Bellvitge University Hospital, Barcelona, Spain Corresponding author: Albert Ariza-Solé, Cardiology Department, Heart Disease Institute, Bellvitge University Hospital, Feixa Llarga s/n. 08907, L’Hospitalet de Llobregat, Barcelona 08907, Spain. Email: aariza@bellvitgehospital.cat Downloaded from https://academic.oup.com/ehjacc/article/9/2/128/5933389 by KIM Hohenheim user on 21 April 2022