Tani Akihiro, Aramaki Kazuhiko, Uno Shota, Morisako Natsumi, Hagiwara Takashi, Iwasaki Tsukasa, Nishiyama Shigeki, Kaneyama Junji, Yanagisawa Ryoji, Shibasaki Taro, Koji Yutaka, Iida Takashi, Irie Tadanobu, Kato Yasuyuki, Yamane Masahisa
Saitama Sekishinkai Hospital, 2-37-20 Irumagawa, Sayama, Saitama, Japan.
Heart Vessels. 2025 Jan 26. doi: 10.1007/s00380-025-02513-x.
Postinfarction ventricular septal rupture (PIVSR) is a rare but serious complication of acute myocardial infarction. Determining how to conduct surgical repair safely is critical. We compared the outcomes of Impella and intra-aortic balloon pump (IABP) implantation during perioperative mechanical circulatory support management in patients with PIVSR (n = 22). The primary endpoint was the 12-month survival rate. Secondary endpoints included major adverse cardiovascular events (MACEs) and the number of waiting days for surgery. Using the log-rank test, we compared Kaplan-Meier curves between the groups. The 12-month survival rate was 87.5% and 53.6% in the Impella and IABP groups, respectively, with no significant difference (p = 0.17). The median number of days from circulatory support implantation to surgery was longer in the Impella group than in the IABP group (2.5 days vs. 1.0 days, interquartile range: 1.8-5.2 vs. 0-1.0; p = 0.003). In the subgroup analysis considering only the Society for Cardiovascular Angiography and Interventions (SCAI) shock stages B-D, the 12-month survival rate was higher (85.7% vs. 18.8%; p = 0.03) and the MACE rate was lower (14.3% vs. 53.3%; p = 0.010) in the Impella group than in the IABP group. In summary, when focusing on the SCAI shock stages B-D, the Impella group had significantly better outcomes than did the IABP group. In the perioperative management of PIVSR, the use of Impella may be more beneficial than the use of IABPs, particularly in patients with SCAI shock stages B-D.
心肌梗死后室间隔破裂（PIVSR）是急性心肌梗死一种罕见但严重的并发症。确定如何安全地进行手术修复至关重要。我们比较了在PIVSR患者（n = 22）围手术期机械循环支持管理期间，使用Impella和主动脉内球囊反搏（IABP）植入的效果。主要终点是12个月生存率。次要终点包括主要不良心血管事件（MACE）和手术等待天数。我们使用对数秩检验比较了两组之间的Kaplan-Meier曲线。Impella组和IABP组的12个月生存率分别为87.5%和53.6%，无显著差异（p = 0.17）。Impella组从循环支持植入到手术的中位天数比IABP组长（2.5天对1.0天，四分位间距：1.8 - 5.2对0 - 1.0；p = 0.003）。在仅考虑心血管造影和介入学会（SCAI）休克分级B - D的亚组分析中，Impella组的12个月生存率更高（85.7%对18.8%；p = 0.03），MACE发生率更低（14.3%对53.3%；p = 0.010）。总之，当关注SCAI休克分级B - D时，Impella组的效果明显优于IABP组。在PIVSR的围手术期管理中，使用Impella可能比使用IABP更有益，特别是在SCAI休克分级B - D的患者中。
