Does extracorporeal life support influence outcome after surgical management of post infarct ventricular septal...

Ventricular septal rupture (VSR) is an uncommon but life-threatening complication of acute myocardial infarction. Extra corporeal life support (ECLS) use in the preoperative setting allows hemodynamic stabilization for a delayed surgery. We aimed to assess the role of ECLS in the preoperative period of post infarction VSR surgery.

We retrospectively analyzed all consecutive patients operated for VSR between January 2007 and August 2019. We assessed baseline characteristics, pre and post-operative clinical status and the use of ECLS in the peri-operative period.

A total of 39 patients were included. Mean age was 69.8 years. In-hospital mortality was 48.7%. Survivors and non-survivor patients had similar characteristics except for lower postoperative ejection fraction (32% vs. 42%, P=0.02) and more acute renal failure (71.4% vs. 10%, P=0.0005) in the non-survivor group. Patients who received ECLS preoperatively were younger (72 vs. 65, P=0.02) and had more preoperative invasive ventilation (16% vs. 50%, P=0.04). Cardiopulmonary bypass (CPB, 140 min vs. 75 min, P=0.0008) and cross clamping times (94 min vs. 52 min, P=0.0026) were significantly higher in the ECLS group. There were more bleeding complications in the ECMO group (45.4% vs. 0%, P=0.0019) and more need for reintervention (63.3% vs. 13%, P=0.015). There was no difference in mortality between the two groups. There was no difference in postoperative characteristics between urgent and delayed surgery.

In our study, post-operative ECLS use was associated with more bleeding complications and need for reintervention. Although mortality was similar, bleeding complications remain a major limitation for the systematic use of ECLS in the post-operative period.