Post-infarct ventricular septal rupture: early Impella implantation to delay surgery and reduce surgical risk

Ventricular septal rupture (VSR) is a complication of myocardial infarction. Surgery is the only treatment; however, mortality is high, especially if it is performed within 7 days from presentation. The improved outcome with delayed intervention could be related to evolution of the infarct, which allows a more effective surgical repair. However, it is also a representation of survival bias, as an early surgery is usually performed on individuals with hemodynamic instability. We present a case of VSR complicated by cardiogenic shock. An early hemodynamic stabilization was achieved with Impella implantation; the delay in surgery allowed a reduction in surgical risk.