Delayed surgery after mechanical circulatory support for ventricular septal rupture with cardiogenic shock

The effectiveness of delayed surgery for ventricular septal rupture (VSR) following myocardial infarction (MI) in patients with cardiogenic shock remains unknown. We aimed to investigate the outcomes of delayed surgery following mechanical circulatory support for patients in cardiogenic shock after VSR.

We reviewed 8 patients with post-MI VSR and cardiogenic shock who underwent delayed surgery at our institution between July 2015 and November 2017. Surgery was delayed until haemodynamic stabilization and improved organ ischaemia were achieved by initiating intra-aortic balloon pumping with or without veno-arterial extracorporeal membrane oxygenation (ECMO). We investigated the operative mortality, morbidity and late survival.

All 8 patients had preoperative intra-aortic balloon pump support, and 5 had additional veno-arterial ECMO support. Emergency repair was successfully avoided in all cases. The median time from the onset of MI to operation was 7.1 (3.7-9.9) days, and that from the diagnosis of VSR to operation was 1.9 (1.3-2.3) days. The operative mortality was 12.5%, and complications related to mechanical circulatory support occurred in 1 case (12.5%). The 2-year survival rate was 62.5%.

A combination of preoperative mechanical circulatory support and delayed surgery may improve the outcomes of patients with post-MI VSR, which was complicated by cardiogenic shock. The key to a better surgical outcome may be delaying the surgery for improving end-organ perfusion. This requires further investigation, especially for determining the optimal duration of support.