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Published on: July 18, 2014
Transition to heart transplantation in post-myocardial infarction ventricular septal rupture: a systematic review
Bernardo Perez-Villa1, Roberto J Cubeddu2, Nicolas Brozzi3
1Heart, Vascular and Thoracic Institute, Cleveland Clinic Florida, FL, Weston, USA. perezvb@ccf.org.
Insights
Heart transplantation (HT) can be a viable primary or bailout strategy for post-myocardial infarction ventricular septal rupture (MI-VSR). Mechanical circulatory support (MCS) can bridge patients to HT, reducing high in-hospital mortality rates.
Area of Science:
- Cardiology
- Cardiac Surgery
- Transplantation Medicine
Background:
- Post-myocardial infarction ventricular septal rupture (MI-VSR) is a severe complication with a poor prognosis.
- Surgical repair is the standard treatment, but heart transplantation (HT) is rarely considered.
Approach:
- A systematic review of case reports (CRs) was conducted to evaluate HT in MI-VSR patients.
- Data from 14 CRs (1994-2015) involving 17 adult patients were analyzed.
- The CARE case report guideline was used to assess the quality of included CRs.
Key Points:
- 17 adult patients with MI-VSR treated with HT (primary or bailout) were analyzed.
- 12 patients underwent HT; 5 died awaiting transplantation on mechanical circulatory support (MCS).
- In-hospital mortality was 29%; 6 patients survived 6 months and 1 year post-HT.
Conclusions:
- HT, especially when supported by MCS as a bridge, may be a feasible strategy for MI-VSR.
- This approach could potentially decrease the high in-hospital mortality associated with MI-VSR.
- Further research is needed to establish HT's role in managing MI-VSR.
Abstract:
Post-myocardial infarction ventricular septal rupture (MI-VSR) remains a dreadful complication with dismal prognosis. Surgical repair is the primary treatment strategy, whereas the role of heart transplantation (HT) as a primary option in MI-VSR is limited to case reports (CRs). We performed a systematic review of CRs to describe in-hospital mortality, and survival at 6 and 12 months in adult patients with MI-VSR treated with HT as a primary or bailout strategy. We performed a comprehensive search of Web of Science, PubMed, and Ovid Medline. The last search was completed on March 10, 2020. An aggregated score based on the CARE case report guideline was used to assess the quality of the CRs. We included CRs that described adult patients with MI-VSR treated with HT as a primary or bailout strategy. A total of 14 CRs between 1994 and 2015 were included, retrieving and analyzing the characteristics of 17 patients. A total of 12 patients underwent HT, with HT being the primary strategy in 8 patients and a bailout strategy for 4 patients following initial surgical repair, while 5 patients died awaiting HT under mechanical circulatory support (MCS), accounting for the total in-hospital mortality of this series (29%). Regarding long-term outcomes, 6 patients were reported to be alive at 6 months and 1 year after HT, while information was missing in the remaining 6 patients. In conclusion, HT supported by the use of temporary and durable MCS as a bridge to HT could be a feasible primary or bailout strategy to reduce the high in-hospital mortality of patients with MI-VSR.
