Implantable left ventricular assist device for patients with postinfarction ventricular septal defect

Faber, Cristiano; McCarthy, Patrick M.; Smedira, Nicholas G.; Young, James B.; Starling, Randall C.; Hoercher, Katherine J.

doi:10.1067/mtc.2002.124243

Cited by 29 publications

(19 citation statements)

References 4 publications

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“…The management of the PI VSD is challenging. The timing of intervention remains controversial, and both surgical and percutaneous closure are associated with significant mortality [1][2][3]. Although the rates of PI VSD have dropped since the advent of thrombolysis from 1-2% of myocardial infarctions to about 0.3%, it still carries a mortality of >90% at 30 days for those patients medically managed [1].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Post-infarct ventricular septal defect (PI VSD) is a well-recognised complication of acute myocardial infarction which, if untreated, confers mortality greater than 90% [1]. Both surgical and percutaneous approaches to closure are associated with high morbidity and mortality [1]. Timing of intervention remains controversial, with equipoise surrounding balancing the risk of early surgery to prevent haemodynamic collapse and multi-organ failure, with the risk associated with delaying surgery to allow for organisation of recently infarcted tissue which increases the chance of operative success.…”

Section: Introductionmentioning

confidence: 99%

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Veno-Arterial ECMO in the Setting of Post-Infarct Ventricular Septal Defect: A Bridge to Surgical Repair

McLaughlin

McGiffin

Winearls

et al. 2016

Heart, Lung and Circulation

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Veno-Arterial ECMO in the Setting of Post-Infarct Ventricular Septal Defect: A Bridge to Surgical Repair

McLaughlin

McGiffin

Winearls

et al. 2016

Heart, Lung and Circulation

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“…Despite successful surgical repair of VSR, some patients with extensive infarction and persistent ventricular failure remain in cardiogenic shock and require VAD support to maintain physiologic haemodynamics. Implantable LVADs have been used successfully to bridge these patients to cardiac transplantation [34]. …”

Section: Discussionmentioning

confidence: 99%

Outcome and survival analysis of surgical repair of post-infarction ventricular septal rupture

Pang

Sin

Lim

et al. 2013

J Cardiothorac Surg

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BackgroundTo review the experience of surgical repair of post-infarction ventricular septal rupture (VSR) and analyze the associated outcomes and prognostic factors.MethodsFollowing approval from the Singhealth Centralised Institutional Review Board (reference: 2011/881/C), a retrospective review was performed on 38 consecutive patients who had undergone surgical repair of post-infarction VSR between 1999 and 2011. Continuous variables were expressed as either mean ± standard deviation or median with 25th and 75th percentiles. These were compared using two-tailed t-test or Mann–Whitney U test respectively. Categorical variables were compared using chi-square or Fisher’s exact test. To identify predictors of operative mortality, univariate analysis of perioperative variables followed by multivariate analysis of significant univariate risk factors was performed. A two-tailed p-value < 0.05 was used to indicate statistical significance.ResultsMean age was 65.7 ± 9.4 years with 52.6% males. The VSR was anterior in 28 (73.7%) and posterior in 10 patients. Median interval from myocardial infarction to VSR was 1 day (1, 4). Pre-operative intra-aortic balloon pump was inserted in 37 patients (97.8%). Thirty-six patients (94.7%) underwent coronary angiography.Thirty-five patients (92.1%) underwent patch repair. Mean aortic cross clamp time was 82 ± 40 minutes and mean cardiopulmonary bypass time was 152 ± 52 minutes. Coronary artery bypass grafting (CABG) was performed in 19 patients (50%), with a mean of 1.5 ± 0.7 distal anastomoses. Operative mortality within 30 days was 39.5%.Univariate analysis identified emergency surgery, New York Heart Association (NYHA) class, inotropic support, right ventricular dysfunction, EuroSCORE II, intra-operative red cell transfusion, post-operative renal failure and renal replacement therapy (RRT) as predictors of operative mortality. Multivariate analysis identified NYHA class and post-operative RRT as predictors of operative mortality.Ten year overall survival was 44.4 ± 8.4%. Right ventricular dysfunction, LVEF and NYHA class at presentation were independent factors affecting long-term survival. Concomitant CABG did not influence early or late survival.ConclusionsSurgical repair of post-infarction VSR carries a high operative mortality. NYHA class at presentation and post-operative RRT are predictors of early mortality. Right ventricular dysfunction, LVEF and NYHA class at presentation affect long-term survival. Concomitant CABG does not improve survival.

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“…11,12,16,18,[27][28][29][30] Treatment with a left ventricular (LV) assist device has also been described for patients with an acute VSR and heart failure. 31,32 Potential problems with this technique involve cannulation of an infarcted left ventricular apex, the risk of aspiration of thrombotic material from the LV into the pump, the lack of right ventricular mechanical support, and systemic hypoxemia related to right-to-left shunting of deoxygenated blood through the VSR. For these reasons, VA ECMO with delayed repair might be a superior strategy as well as avoiding the considerable cost of the VAD.…”

Section: Postinfarction Ventricular Septal Rupturementioning

confidence: 99%

ECMO as a bridge to non-transplant cardiac surgery

2017

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Implantable left ventricular assist device for patients with postinfarction ventricular septal defect

Cited by 29 publications

References 4 publications

Veno-Arterial ECMO in the Setting of Post-Infarct Ventricular Septal Defect: A Bridge to Surgical Repair

Veno-Arterial ECMO in the Setting of Post-Infarct Ventricular Septal Defect: A Bridge to Surgical Repair

Outcome and survival analysis of surgical repair of post-infarction ventricular septal rupture

ECMO as a bridge to non-transplant cardiac surgery

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