Funding Acknowledgements Type of funding sources: None. Backgroud Ventricular septal defect (VSD), is a rare but fatal complication of myocardial infarction (MI) associated with high early mortality. Temporary mechanical circulatory support (t-MCS) of any type can be used to stabilize the patient as a bridge to surgical or percutaneous closure, or to heart transplantation or long-term ventricular assist device, but with a low level of evidence. The Impella® device is a trans-valvular aortic axial pump inserted surgically or percutaneously which pumps blood directly from the left ventricle into above the aortic valve. Its hemodynamic effects seem interesting, explaining its use by certain expert centers in this context, but the data in this indication are rare in the literature. Method It was an European retrospective multicentre registry of patients hospitalized for ischemic VSD managed with an Impella® (2.5, CP or 5.0) over the past 10 years (2010 to 2021). The primary endpoint was in-hospital mortality. The secondary endpoints were the monitoring of clinical, hemodynamic and biological data at 24 hours, the medications and organ supports used during hospitalization, intra-hospital complications and mortality at 6 months and 1 year. Results On 20 centers contacted, 17 responded (85%). A total of 28 patients managed with an Impella® device for an ischemic VSD in 7 European center were included (41% of respondents). All patients included were in cardiogenic shock (100%, n=28) with multiple organ failure (SAPSII 41 [IQR 53-27], Euroscore 57 [IQR 75-23] and arterial lactate 6 +/-5 mmol). The majority of patients required inotropic and vasopressor support (dobutamine 55% and norepinephrine 96%). In-hospital and 1-year mortalities were 75%. Surgical closure of the VSD was performed in 36% of patients, percutaneous closure in 21% and medical treatment alone for 43, with in-hospital mortality of 30, 92 and 100% respectively. Hospital mortality also seemed to be associated with the type of t-MCS used (71% for Impella alone, 67% for Impella® with IABP combination and 78% for Impella® with ECLS combination). Survivors were more likely to have benefited from CABG revascularization (p < 0.011). Conclusion Despite the potential hemodynamic advantages, the use of Impella® in patients with ischemic VSD is associated with high mortality which may be partly related to its exclusive use in the most severe cardiogenic shock patients, to associated therapies in particular the type of closure of the VSD, or the complications of the device itself.

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Funding Acknowledgements Type of funding sources: None. Introduction Recent advances in percutaneous mechanical thrombectomy provide lytic-free methods for treatment of pulmonary embolism (PE). Although guidelines recommend aspirational embolectomy only for high-risk PE patients with contraindication to or failed fibrinolysis, the method is currently being used in treatment of intermediate-high risk PE patients. We present our initial experiences with large bore percutaneous aspirational embolectomy catheter. Methods Patients with intermediate-high risk PE and at least one clinical feature (persistent hypoxemia, tachycardia, hypotension without shock, or dyspnoea on minimal exertion) were considered eligible for the method. Positive high-sensitive troponin was obligatory. PE was diagnosed by computed tomography. Echocardiography and doppler ultrasound of lower limbs venous system were performed upon admission. All procedures were performed by interventional cardiologist in cardiology suite. Light sedation with dexmedetomidine and/or midazolam was used. Ultrasound guided right or left femoral approach was used in all patients. A 7F balloon tipped catheter was used to cross the tricuspid and pulmonary valves and engage pulmonary artery (PA). After exchanging for 6F pigtail catheter an angiography was performed. Then, via multipurpose 6F catheter an extra-stiff wire was introduced distal to the thrombus. Over the wire a 20F or 24F aspirational embolectomy catheter was placed in front of the thrombus followed by the aspiration with 60 ml syringe. Up to 10 aspirations were allowed. Unfractionated heparin was used for periprocedural anticoagulation followed by apixaban or rivaroxaban as soon as hemostasis was achieved. Patients outcomes were recorded prospectively. Results From March to October 2022 a total of 10 patients were treated with aspirational embolectomy (6 females, median age 68.5 years (interquartile range 53.25-74)). Only the first case was performed with 20F catheter. In 9 patients sheathless approach was used due to material unavailability. In one case switching to left-side access was required due to inability to introduce the catheter in common femoral vein. In two cases a "lollipop" phenomenon occurred, one of which was a thrombus-in-transit (TIT) case. This case was complicated with TIT fragmentation on exit and re-embolism with circulatory arrest requiring veno-arterial extracorporeal circulatory support. Procedural success was achieved in all cases (in TIT patient two procedures were needed). All patients reported improvements in dyspnea levels. One patient required oxygen supplementation beyond 24h (TIT patient). Average PA systolic and diastolic blood pressure drop was 24.3±11.0 and 12.3±4.9 mmHg. Nine patients were alive at discharge, while TIT patient was still requiring hospitalisation. Conclusion Aspirational embolectomy can provide sufficient drop in PA pressures and symptom relief. Randomised trials are needed to determine the long term outcomes of the procedure.