Key result
Full presurgical hemodynamic support linked to ~39 percentage-point lower 1-year mortality in post-MI VSD.
Why the study?
Ventricular septal defects are life-threatening complications of myocardial infarctions, and the role of presurgical hemodynamic support remains unclear.
Does full presurgical hemodynamic support (Impella 5.0/5.5 and/or VA-ECMO) improve survival compared to partial support in patients with cardiogenic shock complicating post-myocardial infarction ventricular septal defect?
Cohort (n=29)
No
Does full presurgical hemodynamic support (Impella 5.0/5.5 and/or VA-ECMO) improve survival compared to partial support in patients with cardiogenic shock complicating post-myocardial infarction ventricular septal defect?
Initiating full mechanical circulatory support (Impella 5.0/5.5 or VA-ECMO) in patients with cardiogenic shock due to a post-MI VSD may allow for safely delaying surgical repair and is associated with significantly better 1-year survival compared to lower levels of presurgical support.
Answers are grounded in this paper and cite their sources.
Full presurgical support was associated with lower mortality in post-MI VSD shock; hypothesis-generating and requires randomized confirmation before practice change.
Objectives: Ventricular septal defects (VSDs) are life-threatening complications of myocardial infarctions (MIs), and the role of presurgical hemodynamic support remains unclear. This study compared outcomes of patients with post-MI VSDs in cardiogenic shock (CS) receiving different levels of presurgical hemodynamic support. Methods: Patients from January 1, 2011, to December 31, 2024, in CS with post-MI VSDs undergoing surgical patch repair at this single center were included. Patients with intra-aortic balloon pumps (IABP), Impella CP, or only pharmacologic presurgical hemodynamic support were placed in the partial support (PS) group; patients on venoarterial-extracorporeal membrane oxygenation (VA-ECMO) and/or Impella 5.0/5.5 before surgery were placed in the full support (FS) group. Discharge and 1-year clinical outcomes plus complications were compared between groups. Postprocedural complications were similar between groups. Conclusions: Among patients with post-MI VSDs in CS, 1-year mortality was significantly lower among patients on full presurgical hemodynamic support as compared with partial presurgical hemodynamic support.
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D’Angelo et al. (2026) conducted a cohort in Post-myocardial infarction ventricular septal defect in cardiogenic shock (n=29). Full presurgical hemodynamic support (Impella 5.0/5.5 and/or VA-ECMO) vs. Partial presurgical hemodynamic support (IABP, Impella CP, or solely pharmacologic support) was evaluated on 1-year all-cause mortality (p=0.050). Among patients with post-MI VSDs in cardiogenic shock, full presurgical hemodynamic support significantly lowered 1-year mortality compared to partial support (14.3% vs 53.3%, P=0.050).
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