Impella for the Management of Ventricular Septal Defect Complicating Acute Myocardial Infarction: A European Multicenter Registry

Abstract

Ventricular septal defect (VSD) is a rare but severe complication of myocardial infarction (MI). Temporary mechanical circulatory support (MCS) can be used as a bridge to VSD closure, heart transplantation, or ventricular assist device. We describe the use of Impella device in this context based on a multicenter European retrospective registry (17 centers responded). Twenty-eight post-MI VSD patients were included (Impella device were 2.5 for 1 patient, CP for 20, 5.0 for 5, and unknown for 2). All patients were in cardiogenic shock with multiple organ failure (SAPS II 41 [interquantile range {IQR} = 27–53], lactate 4.0 ± 3.5 mmol/L) and catecholamine support (dobutamine 55% and norepinephrine 96%). Additional temporary MCS was used in 14 patients (50%), mainly extracorporeal life support (ECLS) (n = 9, 32%). Severe bleedings were frequent (50%). In-hospital and 1 year mortalities were 75%. Ventricular septal defect management was surgical for 36% of patients, percutaneous for 21%, and conservative for 43%. Only surgically managed patients survived (70% in-hospital survival). Type and combination of temporary MCS used were not associated with mortality (Impella alone or in combination with intra-aortic balloon pump [IABP] or ECLS, p = 0.84). Impella use in patients with post-MI VSD is feasible but larger prospective registries are necessary to further elucidate potential benefits of left ventricular unloading in this setting.

Delayed closure of ventricular septal defect with prolonged mechanical support

“…A multicentre study involving 28 patients reported high mortality with the use of MCS devices, including Impella. However, the study included severe cases with multi-organ failure [ 6 ] .…”

Complications in Acute Myocardial Infarction: Navigating Challenges in Diagnosis and Management

“…Unstable patients may necessitate the use of an Intra-Aortic Balloon Pump (IABP) or Extracorporeal Membrane Oxygenation (ECMO). In a multicenter European registry study that investigated the utilization of the Impella device as a temporary mechanical circulatory support in 28 patients with post-MI VSR, it was found that, although Impella demonstrated feasibility in addressing the interventricular shunt in these patients, it was associated with a high mortality rate of 75%, with 50% of cases experiencing severe bleeding [26]. Notably, patients who did not undergo surgical repair did not survive.…”