Impact of initial axillary microaxial flow pump on post-myocardial infarction ventricular septal defect management

The mortality rate of ventricular septal defect (VSD) following acute myocardial infarction remains high. Mechanical circulatory support devices have been shown to facilitate delayed surgery and improve postoperative survival, although clear guidelines for device selection are lacking.

This study presents a retrospective cohort analysis of 18 patients with post-infarction VSD treated with microaxial flow pump (mAFP) from March 2017 to November 2024. Patients were divided into two groups: the Percutaneous group utilized Impella 2.5 or CP (Abiomed, Danvers, MA, USA) and the Axillary access group (Impella 5.0 or 5.5). Their clinical outcomes and early to midterm survival rates were analyzed.

The survival discharge rate was 31% (4 in 13 patients) in the Percutaneous group and 100% (5 patients) in the Axillary access group, with a significant difference (p = 0.029). 7 patients who were initially managed with percutaneous mAFP and later required the addition of extracorporeal membrane oxygenation all died perioperatively. The 100-day Kaplan-Meier analysis showed a significant improvement in survival rates in the Axillary access group compared to the Percutaneous group. (Log-rank, p = 0.020).

These findings illustrate variation in surgical timing and device selection, and suggest that the early use of an axillary-access mAFP may warrant further investigation in post-myocardial infarction VSD patients.