Successful Bridge to Surgical Repair of Postinfarct Ventricular Septal Defect With Impella 5.5

Postinfarction ventricular septal defects (VSDs) are a rare yet critical condition that can occur following a myocardial infarction. Initial management typically includes medical support and mechanical circulatory devices, such as extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pumps (IABP). However, the utility of Impella 5.5 in bridging postinfarct VSDs to surgical repair is an emerging new approach. This case report presents a 70 year old male with a postinfarct VSD and the successful use of Impella 5.5 to bridge him to surgical repair. After experiencing dyspnea and chest discomfort, the patient was diagnosed with a 100% occlusion of the left anterior descending artery, which was successfully treated with a drug-eluting stent. On re-admission for hemoptysis and shortness of breath, a ventricular septal rupture was identified, necessitating urgent surgical consultation. The patient was initially managed on an IABP and then converted to Impella 5.5. After stabilization of cardiogenic shock and improvement in the left-to-right shunt, he was taken to the operating room for repair. The VSD was closed using a single patch technique and an aneurysmectomy was performed. This case illustrates the potential utility of Impella 5.5 in managing postinfarct VSDs.