Physiological Effects and Clinical Limitations of Impella-Bridge Strategy for Post-Infarction Ventricular Septal Rupture.

BACKGROUND

Post-infarction ventricular septal rupture (VSR) remains a life-threatening mechanical complication of acute myocardial infarction. We evaluated the feasibility of an Impella-bridge strategy for scheduled VSR repair.

METHODS

We retrospectively analyzed 10 consecutive patients with post-infarction VSR who were transferred to our institution and managed with Impella support. Outcomes included achievement of scheduled repair and serial changes in hemodynamic parameters and organ dysfunction during the bridging period.

RESULTS

The median age was 74 years. All patients received Impella 2.5 or CP support after transfer; veno-arterial extracorporeal life support was added in four patients, and Impella support was upgraded in one patient. The median duration from Impella initiation to VSR repair was 8 (7, 10) days. Scheduled repair was achieved in nine patients (90%). Mean pulmonary artery pressure, central venous pressure, plasma B-type natriuretic peptide levels, and lactate decreased over time before repair, whereas non-CNS SOFA scores increased during bridging.

CONCLUSIONS

In patients with post-infarction VSR, an Impella-bridge strategy may help achieve scheduled VSR repair with improved hemodynamic stabilization; however, SOFA-defined abnormalities, organ support requirements, and device-related complications were observed during the bridging period. Further studies are needed to define patient selection, management strategies, and the optimal timing of repair for this strategy.