Perez-Villa Bernardo, Cubeddu Roberto J, Brozzi Nicolas, Sleiman Jose R, Navia Jose, Hernandez-Montfort Jaime
Heart, Vascular and Thoracic Institute, Cleveland Clinic Florida, FL, Weston, USA.
Naples Heart Institute, NCH Healthcare System, FL, Naples, USA.
Heart Fail Rev. 2023 Jan;28(1):217-227. doi: 10.1007/s10741-021-10161-2. Epub 2021 Oct 21.
Post-myocardial infarction ventricular septal rupture (MI-VSR) remains a dreadful complication with dismal prognosis. Surgical repair is the primary treatment strategy, whereas the role of heart transplantation (HT) as a primary option in MI-VSR is limited to case reports (CRs). We performed a systematic review of CRs to describe in-hospital mortality, and survival at 6 and 12 months in adult patients with MI-VSR treated with HT as a primary or bailout strategy. We performed a comprehensive search of Web of Science, PubMed, and Ovid Medline. The last search was completed on March 10, 2020. An aggregated score based on the CARE case report guideline was used to assess the quality of the CRs. We included CRs that described adult patients with MI-VSR treated with HT as a primary or bailout strategy. A total of 14 CRs between 1994 and 2015 were included, retrieving and analyzing the characteristics of 17 patients. A total of 12 patients underwent HT, with HT being the primary strategy in 8 patients and a bailout strategy for 4 patients following initial surgical repair, while 5 patients died awaiting HT under mechanical circulatory support (MCS), accounting for the total in-hospital mortality of this series (29%). Regarding long-term outcomes, 6 patients were reported to be alive at 6 months and 1 year after HT, while information was missing in the remaining 6 patients. In conclusion, HT supported by the use of temporary and durable MCS as a bridge to HT could be a feasible primary or bailout strategy to reduce the high in-hospital mortality of patients with MI-VSR.
心肌梗死后室间隔破裂（MI-VSR）仍然是一种可怕的并发症，预后不佳。手术修复是主要的治疗策略，而心脏移植（HT）作为MI-VSR的主要选择的作用仅限于病例报告（CRs）。我们对病例报告进行了系统回顾，以描述采用HT作为主要或补救策略治疗的成年MI-VSR患者的住院死亡率以及6个月和12个月时的生存率。我们对科学网、PubMed和Ovid Medline进行了全面检索。最后一次检索于2020年3月10日完成。基于CARE病例报告指南的综合评分用于评估病例报告的质量。我们纳入了描述采用HT作为主要或补救策略治疗的成年MI-VSR患者的病例报告。共纳入了1994年至2015年间的14篇病例报告，检索并分析了17例患者的特征。共有12例患者接受了心脏移植，其中8例患者将心脏移植作为主要策略，4例患者在初次手术修复后将其作为补救策略，另有5例患者在机械循环支持（MCS）下等待心脏移植时死亡，占该系列患者总住院死亡率（29%）。关于长期结局，据报告6例患者在心脏移植后6个月和1年时存活，其余6例患者信息缺失。总之，使用临时和持久的MCS作为心脏移植的桥梁所支持的心脏移植可能是一种可行的主要或补救策略，以降低MI-VSR患者的高住院死亡率。
