Microaxial Support as a Bridge to Repair in Post-Myocardial Infarction Ventricular Septal Rupture: A Systematic Review and Patient-Level Analysis.

Abstract

Background: Current guidelines recommend immediate surgical repair for post-infarct ventricular septal rupture (VSR); however, mortality remains exceedingly high. We sought to report outcomes following delayed surgical management bridged with microaxial support.

Methods: A comprehensive literature search yielded 42 case reports/series comprising 78 patients who were initiated on microaxial support following the diagnosis of post-infarct VSR. Patient-level data were extracted and analyzed according to survival status.

Results: Overall, 78% (54/69) of patients were male, and the median age was 69 [IQR: 60-74] years, with no difference in age between survivors and non-survivors. Those who survived were significantly less likely to have a history of prior cardiac surgery than non-survivors [3% (1/30) vs. 43% (3/7), p = 0.016], and less likely to have undergone percutaneous coronary intervention at the time of presentation [41% (22/54) vs. 69% (11/16), p = 0.049]. There were no significant differences in culprit vessel (p = 0.875), VSR size (p = 1), or VSR location (p = 0.253). Those who survived had a significantly higher median Qp/Qs ratio than non-survivors [3.0 [2.3-3.8] vs. 2.1 [1.9-2.3], p = 0.038]. Patients were successfully bridged to definitive surgical management in 76% (59/78) of cases at a median time of 8 [5-14] days following microaxial support placement. The 30-day/in-hospital mortality rate was 22% (17/78), and the overall mortality rate was 27% (21/78).

Conclusion: Microaxial devices can safely and feasibly provide the necessary support to allow for a successful delayed repair in hemodynamically unstable patients following post-infarct VSR.