Postmyocardial infarction ventricular septal defect outcomes: Partial versus full presurgical hemodynamic support

Ventricular septal defects (VSDs) are life-threatening complications of myocardial infarctions (MIs), and the role of presurgical hemodynamic support remains unclear. This study compared outcomes of patients with post-MI VSDs in cardiogenic shock (CS) receiving different levels of presurgical hemodynamic support.

Patients from January 1, 2011, to December 31, 2024, in CS with post-MI VSDs undergoing surgical patch repair at this single center were included. Patients with intra-aortic balloon pumps (IABP), Impella CP, or only pharmacologic presurgical hemodynamic support were placed in the partial support (PS) group; patients on venoarterial-extracorporeal membrane oxygenation (VA-ECMO) and/or Impella 5.0/5.5 before surgery were placed in the full support (FS) group. Discharge and 1-year clinical outcomes plus complications were compared between groups.

This study included 29 patients, with 15 patients (51.7%) in the PS group and 14 patients (48.3%) in the FS group. In the PS group, 12 patients (80%) had IABPs, 2 patients (13.3%) had only pharmacologic support, and 1 patient (6.7%) had Impella CP support. In the FS group, 5 patients (35.7%) had Impella 5.0/5.5 alone, 6 patients (42.9%) had IABP plus Impella 5.0/5.5, and 3 patients (21.4%) had IABP, Impella 5.0/5.5, and VA-ECMO. Mortality was greater in the PS group compared with the FS group at discharge (46.7% vs 14.3%, P = .109) and 1 year (53.3% vs 14.3%, P = .050). Postprocedural complications were similar between groups.

Among patients with post-MI VSDs in CS, 1-year mortality was significantly lower among patients on full presurgical hemodynamic support as compared with partial presurgical hemodynamic support.