Improved outcomes in the treatment of post-myocardial infarction ventricular septal defect with percutaneous TandemHeart left ventricular mechanical circulatory support

Abstract

Background Post-myocardial infarction (MI) ventricular septal defect (VSD) is associated with 40% - 50% of peri-procedural mortalities; however, it is amenable to catheter-based therapies. We retrospectively investigated the impact of state-of-the-art bridging percutaneous left ventricular mechanical circulatory support (MCS) using the TandemHeart® (TH) ventricular assist device (VAD) on a patient with post-MI VSD. Results From July 2008 to March 2014, 23 patients were referred for treatment of post-MI VSD. Initially, 18/23 patients required MCS; 12 received an intra-aortic balloon pump (IABP), while 6 received initial TH support. Seven of the IABP patients later required TH support. Catheter-based device VSD closure was performed in 18 of the patients; however, three patients required conversion to conventional open cardiac surgical repair via VSD patch closure due to failure of the catheter-based approach. Five patients with TH underwent planned open cardiac surgical repair due to an anticipated lack of suitability for catheter-based treatment. Results revealed that delayed closure after MI correlated with improved survival. Overall, 30-day and 6-month survival rates were 83% (19/23) and 70% (16/23), respectively. Conclusions Further, Qp/Qs ratios of \u3c2.4 correlated with successful percutaneous VSD repair, and this assessment should be further explored as an assessment to inform clinical judgment in patients with post-MI VSD treatment