Analysis of influencing factors for prognosis of patients with ventricular septal perforation: A single-center retrospective study

Perioperative management of postinfarction ventricular septal rupture: a comparison of Impella with intra-aortic balloon pump

Postinfarction ventricular septal rupture (PIVSR) is a rare but serious complication of acute myocardial infarction. Determining how to conduct surgical repair safely is critical. We compared the outcomes of Impella and intra-aortic balloon pump (IABP) implantation during perioperative mechanical circulatory support management in patients with PIVSR (n = 22). The primary endpoint was the 12-month survival rate. Secondary endpoints included major adverse cardiovascular events (MACEs) and the number of waiting days for surgery. Using the log-rank test, we compared Kaplan-Meier curves between the groups. The 12-month survival rate was 87.5% and 53.6% in the Impella and IABP groups, respectively, with no significant difference (p = 0.17). The median number of days from circulatory support implantation to surgery was longer in the Impella group than in the IABP group (2.5 days vs. 1.0 days, interquartile range: 1.8-5.2 vs. 0-1.0; p = 0.003). In the subgroup analysis considering only the Society for Cardiovascular Angiography and Interventions (SCAI) shock stages B-D, the 12-month survival rate was higher (85.7% vs. 18.8%; p = 0.03) and the MACE rate was lower (14.3% vs. 53.3%; p = 0.010) in the Impella group than in the IABP group. In summary, when focusing on the SCAI shock stages B-D, the Impella group had significantly better outcomes than did the IABP group. In the perioperative management of PIVSR, the use of Impella may be more beneficial than the use of IABPs, particularly in patients with SCAI shock stages B-D.

Surgical closure versus transcatheter closure for ventricular septal defect post-infarction: a meta-analysis

Background

Surgical correction of post-infarct ventricular septal defect (PIVSD) is associated with a significant incidence of morbidity and mortality. The authors aimed to evaluate the effectiveness and safety of surgical versus transcatheter approaches in the management of PIVSD.

Methods

A systematic review and meta-analysis of retrospective from five databases including the Cochrane Library, PubMed, Web of Science, Ovid, and Scopus) until 9 March 2024 was conducted. Risk ratio (RR) for dichotomous outcomes was used and data with a 95% CI are presented.

Results

A total of 7 retrospective observational studies with 603 patients were included in the analysis. Surgical closure was associated with a significantly lower short-term mortality and lower number of residual shunt or re-intervention rate compared to percutaneous closure, with a relative risk (RR) of 1.21 (95% CI:1:00-1.46, P = 0.05) and 2.68 (95% CI: 1.46-4.91, P = 0.001), respectively. Surgical closure was associated with a non-significantly lower long-term mortality rate compared to percutaneous closure, with a relative risk (RR) of 1.10 (95% CI: 0.82-1.48, P = 0.52). No difference is reported when time from acute myocardial infarction (AMI) or PIVSD to intervention is compared groups, with a relative risk (RR) of -0.24 (95% CI: -4.49 to 4.2, P = 0.91).

Conclusion

Our meta-analysis shied the light on the significance of surgical closure in terms of short-term mortality and the need for re-intervention. However, no significant difference was observed in terms of long-term mortality and time to intervention.

Current Understanding of Timing of Surgical Repair for Ventricular Septal Rupture following Acute Myocardial Infarction

BACKGROUND

Ventricular septal rupture (VSR) is a mechanical issue that can occur following an acute myocardial infarction (AMI) and has a high mortality rate. It requires a comprehensive, team-based approach for prompt diagnosis and maintaining stable blood flow. While the occurrence of VSR has lessened over the past hundred years and advancements have been made in treatment techniques, the mortality rate within 30 days can still surpass 40 percent. Surgery is the primary treatment method. For patients with stable blood flow, it is generally considered safer to perform surgery 4-6 weeks after the AMI to repair the VSR. However, the timing of surgery for patients with early instability in their blood flow is still a topic of debate.

SUMMARY

There is a lack of set criteria and standards to determine the best time for surgery in patients with VSR following an infarction who have unstable blood flow, especially when considering the use of blood circulation support devices and other techniques for maintaining blood flow that are used in clinical settings.

KEY MESSAGES

This review outlines the features of different mechanical circulatory support devices utilized in treating VSR, along with the current scoring system designed to direct the treatment approach for VSR patients.