What is the impact of mechanical circulatory support on outcomes in post-infarction ventricular septal rupture with cardiogenic shock? A systematic review

Post-infarction ventricular septal rupture (VSR) complicated by cardiogenic shock (CS) carries in-hospital mortality exceeding 40% despite advances in mechanical circulatory support (MCS). We systematically reviewed PubMed, Embase, Cochrane Library, and Scopus from inception to December 2025. Fourteen studies met inclusion criteria, encompassing 24,916 patients. In-hospital mortality ranged from 33.8% to 87%. The intra-aortic balloon pump (IABP) reduced 30-day mortality exclusively at SCAI A/B stages (OR 0.06, P interaction = 0.023), preventing shock progression rather than treating established shock. Early surgery within 7 days reduced mortality in CS patients (OR 0.76) but increased it in stable patients (OR 1.59). Axillary Impella 5.0/5.5 achieved 100% survival-to-discharge versus 31% for percutaneous access. VA-ECMO rescue after percutaneous microaxial pump failure carried 100% mortality. The proposed haemodynamic-stage-adapted framework represents an expert-informed, hypothesis-generating model intended to support structured multidisciplinary decision-making and to guide prospective research, pending validation in controlled studies. Prospective registries and pragmatic trials are urgently needed.