Azoulay Levi-Dan, Bagate François, Delmas Clément, Paulus Sylvie, Mongardon Nicolas, Abou-Arab Osama, Squara Pierre, Habis Michel, Nougue Hélène, Morichau-Beauchant Tristan, Kimmoun Antoine, Seemann Aurélien, Radu Costin, de Roux Quentin, Treille de Grandsaigne Henri, Fellahi Jean-Luc, Beyls Christophe, Cholley Bernard, Klein Thomas, Gaillet Antoine, Mekontso Dessap Armand
Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Service de Médecine Intensive Réanimation, 1 rue Gustave Eiffel, 94 010, Créteil, France.
Faculté de Médecine, Groupe de recherche clinique CARMAS, Université Paris Est Créteil, Créteil, France.
Crit Care. 2025 Mar 18;29(1):119. doi: 10.1186/s13054-025-05321-x.
Post myocardial infarction ventricular septal defect (PMI-VSD) complicated by refractory cardiogenic shock is associated with an extremely high mortality rate. We sought to evaluate the factors associated with in-ICU mortality in patients with PMI-VSD-related cardiogenic shock.
Patients with PMI-VSD complicated by cardiogenic shock, admitted in 10 French tertiary centers between 2008 and 2022, were retrospectively included. The primary outcome was in-ICU mortality. The timing of surgery was classified as early (≤ 7 days) or late (> 7 days). Multivariable analysis was performed to identify the variables associated with in-ICU mortality.
A total of 138 patients were included (mean age 70 (± 10) years, female sex 54%). Of these, 116 patients (84%) received MCS, including 43 patients (31%) with VA-ECMO. VSD surgical closure was performed in 93 patients (67%, 60 early, 33 late). Only 2 patients had percutaneous closure without surgical repair. A total of 84 patients (61%) died. The type of surgical management strategy was significantly associated with in-ICU mortality (no surgery, 100%; early surgery, 45%; late surgery, 27%; p < 0.001). In all patients, the variables independently associated with in-ICU mortality were: old age (adjusted OR = 1.1, 95%CI [1.02-1.12.], p = 0.004), SOFA score (adjusted OR = 1.2, 95%CI [1.07.-1.37], p = 0.003), and VA-ECMO (adjusted OR = 2.9, 95%CI [1.2-7.7], p = 0.02). In patients with VSD surgical closure, a longer delay between ICU admission and VSD surgical closure was independently associated with decreased in-ICU mortality (adjusted OR = 0.9, 95%CI [0.79-0.96], p = 0.003).
Delayed VSD closure is associated with improved outcomes in PMI-VSD complicated by cardiogenic shock.
#CE SRLF 19-34, #CNIL MR004 2224973, retrospectively registered 04 July 2019.
心肌梗死后室间隔缺损（PMI-VSD）合并难治性心源性休克的死亡率极高。我们旨在评估与PMI-VSD相关性心源性休克患者在重症监护病房（ICU）内死亡相关的因素。
回顾性纳入2008年至2022年期间在法国10家三级医疗中心收治的合并心源性休克的PMI-VSD患者。主要结局是ICU内死亡率。手术时机分为早期（≤7天）或晚期（>7天）。进行多变量分析以确定与ICU内死亡率相关的变量。
共纳入138例患者（平均年龄70（±10）岁，女性占54%）。其中，116例患者（84%）接受了机械循环支持（MCS），包括43例（31%）接受静脉-动脉体外膜肺氧合（VA-ECMO）的患者。93例患者（67%，60例早期手术，33例晚期手术）进行了室间隔缺损手术闭合。只有2例患者进行了经皮闭合而未进行手术修复。共有84例患者（61%）死亡。手术管理策略类型与ICU内死亡率显著相关（未手术，100%；早期手术，45%；晚期手术，27%；p<0.001）。在所有患者中，与ICU内死亡率独立相关的变量为：高龄（校正比值比[OR]=1.1，95%置信区间[CI][1.02-1.12]，p=0.004）、序贯器官衰竭评估（SOFA）评分（校正OR=1.2，95%CI[1.07-1.37]，p=0.003）和VA-ECMO（校正OR=2.9，95%CI[1.2-7.7]，p=0.02）。在进行室间隔缺损手术闭合的患者中，从入住ICU到室间隔缺损手术闭合之间的延迟时间越长，与ICU内死亡率降低独立相关（校正OR=0.9，95%CI[0.79-0.96]，p=0.003）。
延迟室间隔缺损闭合与合并心源性休克的PMI-VSD患者预后改善相关。
#CE SRLF 19-34，#CNIL MR004 2224973，于2019年7月4日进行回顾性注册。
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