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

Abstract

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.