Eghbalzadeh Kaveh, Großmann Clara, Krasivskyi Ihor, Djordjevic Ilija, Kuhn Elmar W, Origel Romero Christian, Bakhtiary Farhad, Mader Navid, Deppe Antje Christin, Wahlers Thorsten C W
Department of Cardiothoracic surgery, Heart Center Cologne, Cologne, Germany.
Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany.
Thorac Cardiovasc Surg. 2025 Apr;73(3):224-229. doi: 10.1055/s-0044-1788982. Epub 2024 Aug 12.
Ventricular septal defects (VSDs) remain a rare but life-threatening complication of myocardial infarction. Although the incidence has decreased due to better treatment options, the mortality rate remains high. The timing of VSD repair remains critical to outcome. The use of mechanical circulatory support is rarely described in the literature, although it may help to delay repair to allow tissue stabilization. While Impella is currently considered contraindicated due to the potential worsening of the right-to-left shunt and possible systemic embolization of necrotic debris, there is no comprehensive evidence for this. Therefore, we aimed to analyze whether the use of Impella 5.5 as a first choice for patients undergoing VSD repair should be considered for discussion.
This retrospective study analyses four consecutive patients who underwent delayed ventricular septal repair after prior implantation of Impella 5.5 (Abiomed Inc., Danvers, Massachusetts, United States).
A total of 75% of patients ( = 3) presented with acute right heart failure prior to implantation with a mean systolic pulmonary artery pressure of 64 ± 3.0 mmHg. Implantation was performed under local anesthesia in three cases. The mean time to surgery was 9.8 ± 3.1 days. All patients remained on the Impella 5.5 device postoperatively. Weaning from Impella 5.5 was successful in 75% ( = 3). The mean length of stay in the intensive care unit was 22.3 ± 7.5 days.
Preoperative implantation of the Impella 5.5 device is a safe and feasible option for patients undergoing VSD repair. Outcomes may be improved by performing Impella implantation under local anesthesia and continuing Impella support after VSD repair. However, it is important to note that these patients represent a high-risk cohort and the mortality rate remains high.
室间隔缺损（VSD）仍然是心肌梗死一种罕见但危及生命的并发症。尽管由于治疗选择的改善发病率有所下降，但死亡率仍然很高。VSD修复的时机仍然对预后至关重要。机械循环支持的使用在文献中很少被描述，尽管它可能有助于推迟修复以允许组织稳定。虽然目前因右向左分流可能恶化以及坏死碎片可能发生全身栓塞而认为Impella是禁忌的，但对此尚无全面证据。因此，我们旨在分析对于接受VSD修复的患者，将Impella 5.5作为首选使用是否应予以讨论。
这项回顾性研究分析了4例在先前植入Impella 5.5（美国马萨诸塞州丹弗斯市Abiomed公司）后接受延迟室间隔修复的连续患者。
共有75%（n = 3）的患者在植入前出现急性右心衰竭，平均收缩期肺动脉压为64±3.0 mmHg。3例在局部麻醉下进行植入。平均手术时间为9.8±3.1天。所有患者术后均保留在Impella 5.5装置上。75%（n = 3）成功撤离Impella 5.5。重症监护病房的平均住院时间为22.3±7.5天。
对于接受VSD修复的患者，术前植入Impella 5.5装置是一种安全可行的选择。在局部麻醉下进行Impella植入并在VSD修复后继续Impella支持可能会改善预后。然而，需要注意的是，这些患者代表高危人群，死亡率仍然很高。
