Intensive Cardiac Care Unit, Cardiology Department, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain.
Heart Surgery Department, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain.
Eur Heart J Acute Cardiovasc Care. 2020 Mar;9(2):128-137. doi: 10.1177/2048872618817485. Epub 2018 Dec 10.
Current guidelines recommend emergency surgical correction in patients with post infarction ventricular septal rupture (PIVSR), but patients with multiorgan failure are commonly managed conservatively because of high surgical risk. We assessed characteristics and outcomes of operated PIVSR patients with or without the use of short-term ventricular assist devices (ST-VADs). We also assessed the impact of a ST-VAD on the performance of surgery.
We retrospectively analysed all consecutive patients with PIVSR between January 2004 and May 2017. Baseline clinical characteristics, use of ST-VAD and performance of surgery during admission were assessed. The main outcome measured was in-hospital mortality.
A total of 28 patients were included. Mean age was 69.2 years. Most patients (20/28, 71.4%) underwent surgical repair. ST-VADs were used in 11/28 patients (39.3%). This percentage progressively increased across the study period, from 22.2% (2/9) in 2004-2011 to 58.3% (7/12) in 2015-2017 (=0.091). Patients undergoing ST-VAD use had poorer INTERMACS status, higher values of creatinine, lactate and alanine aminotransferase and lower left ventricular ejection fraction as compared with operated patients without support. In-hospital mortality did not differ according to the use of ST-VADs in operated patients (27.3% without ST-VAD . 22.2% with ST-VAD, =0.604). All five patients undergoing early preoperative venoarterial extracorporeal membrane oxygenator support and delayed surgery survived at hospital discharge.
ST-VAD use increased in patients with PIVSR. Despite a higher risk profile in operated patients undergoing ST-VAD use, mortality was not significantly different in these patients. Early preoperative venoarterial extracorporeal membrane oxygenation should be considered for very high risk PIVSR patients.
目前的指南建议对梗死后室间隔破裂（PIVSR）患者进行紧急外科修复，但由于手术风险高，多器官衰竭患者通常采用保守治疗。我们评估了使用和不使用短期心室辅助装置（ST-VAD）的手术治疗 PIVSR 患者的特征和结局。我们还评估了 ST-VAD 对手术效果的影响。
我们回顾性分析了 2004 年 1 月至 2017 年 5 月期间所有连续的 PIVSR 患者。评估了入院时的基线临床特征、ST-VAD 的使用情况和手术情况。主要测量的结果是住院死亡率。
共纳入 28 例患者，平均年龄 69.2 岁。大多数患者（20/28，71.4%）接受了手术修复。28 例患者中有 11 例（39.3%）使用了 ST-VAD。这一比例在整个研究期间逐渐增加，从 2004-2011 年的 22.2%（2/9）到 2015-2017 年的 58.3%（7/12）（=0.091）。与未接受支持的手术患者相比，使用 ST-VAD 的患者 INTERMACS 状态较差，肌酐、乳酸和丙氨酸氨基转移酶值较高，左心室射血分数较低。在接受手术治疗的患者中，使用 ST-VAD 与死亡率无关（无 ST-VAD 的患者为 27.3%，使用 ST-VAD 的患者为 22.2%，=0.604）。所有 5 例接受早期术前静脉动脉体外膜肺氧合支持和延迟手术的患者在出院时存活。
在 PIVSR 患者中，ST-VAD 的使用有所增加。尽管使用 ST-VAD 的手术患者的风险状况较高，但这些患者的死亡率没有显著差异。对于极高风险的 PIVSR 患者，应考虑早期术前静脉动脉体外膜肺氧合。
