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Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
Contemporary Outcomes of Temporary Mechanical Circulatory Support Use in Ischemic Ventricular Septal Defect: A U.S.
Suguru Ohira1, Masashi Kai2, Daizo Tanaka3
1Department of Cardiac Surgery, Hartford Hospital, Hartford, CT; University of Connecticut School of Medicine, Farmington, CT.
Background:
Ischemic ventricular septal defect (VSD) remains a lethal complication of acute myocardial infarction, often requiring temporary mechanical circulatory support (tMCS) to stabilize hemodynamics. This study aimed to characterize contemporary use and outcomes of tMCS in ischemic VSD across U.S. transplant centers.
Methods:
Retrospective data from seven centers (2014-2023) were analyzed, including 117 patients with ischemic VSD. Sixty patients received extracorporeal membrane oxygenation (ECMO group) and 57 did not (No-ECMO group). Clinical characteristics, intervention types, and outcomes were compared.
Results:
The mean annual case per each center ranged from 1 to 2.5 per year. Overall, 89.7% of patients required tMCS, most commonly intra-aortic balloon pump (62.4%). VA-ECMO was used in 51.3%, often combined with IABP or Impella. The ECMO group exhibited greater preoperative acuity, with higher lactate, creatinine, and transaminases, and worse ventricular function. Mortality before any intervention was significantly higher with ECMO (30.0% vs. 1.8%, p<0.001). Among those undergoing intervention, hospital mortality was 52.4% in the ECMO group and 28.6% without ECMO (p<0.001). Seven patients received advanced therapy (durable left ventricular assist device (LVAD), [concomitant LVAD and VSD repair: N=3, and reoperative LVAD after VSD repair, N=3], and heart transplant, N=1) with mortality of 28.6%. Multivariable analysis identified requirement of ECMO support, lactate ≥3 mmol/L, and LVEF < 50% as independent predictors of mortality.
Conclusions:
Ischemic VSD often necessitates tMCS, with VA-ECMO support in nearly half of cases. Although the outcomes remain guarded, advancements in tMCS technology, patient selection, and comprehensive approach are crucial in this challenging population.
