Key result
Preoperative MCS followed by delayed surgery shows promise for post-infarction VSR in cardiogenic shock.
Why the study?
Delayed surgery for post-infarction VSR improves outcomes versus urgent surgery, but the impact of initial hemodynamic status remains unclear.
Does preoperative mechanical circulatory support improve outcomes in patients with post-infarction ventricular septal rupture in cardiogenic shock undergoing delayed surgery?
Does preoperative mechanical circulatory support improve outcomes in patients with post-infarction ventricular septal rupture in cardiogenic shock undergoing delayed surgery?
Preoperative mechanical circulatory support may be a promising strategy to stabilize patients with post-infarction ventricular septal rupture and cardiogenic shock to allow for delayed surgical repair.
May support preoperative stabilization for delayed repair in shock; leaves open prospective validation.
Post-infarction ventricular septal rupture (VSR) is a serious complication of myocardial infarction, which, in its natural course or treated medically, is related to high mortality rate. Surgical intervention remains the treatment of choice. Recent studies have shown that delayed surgery is related to better outcomes in comparison with urgent surgery; however, in many studies the impact of the patients' initial hemodynamic status on the treatment outcomes often remains unclear. In this review, we analyze the outcomes of delayed surgical treatment of patients in cardiogenic shock in the course of post-infarction ventricular septal defect stabilized with preoperative use of mechanical circulatory support. We evaluate the importance of various types of mechanical circulatory devices (MCD), such as extracorporeal membrane oxygenation, Tandem Heart, Impella, and intra-aortic baloon pump (IABP) in preoperative stabilization of patients, and the most suitable time for surgery, and we also present the features of ideal MCD for patients with VSR. A search of Pubmed to identify studies concerning the use of MCD in patients in cardiogenic shock in the course of VSR qualified for delayed surgery was conducted in January 2022. A total of 16 articles with three or more patients described were analyzed in this study. The preoperative use of MCD in patients in cardiogenic shock and delayed surgery as a main part of treatment seems to be a promising direction, however, it requires further research.
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Żbikowska et al. (2022) conducted a review in Post-infarction ventricular septal rupture in cardiogenic shock. Mechanical circulatory support and delayed surgery was evaluated. Preoperative mechanical circulatory support followed by delayed surgery is a promising strategy for post-infarction ventricular septal rupture in cardiogenic shock, based on a review of 16 articles.
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