Perioperative use of TandemHeart percutaneous ventricular assist device in surgical repair of postinfarction ventricular septal defect.

Abstract

Mortality for patients presenting with acute myocardial infarction (AMI) complicated by ventricular septal defect (VSD) and cardiogenic shock is very high even with surgical repair. We report our experience regarding utilization of TandemHeart, a percutaneous ventricular assist device (pVAD) as an adjunct to the treatment of these patients. Retrospective case series study design included a total of 11 patients with post-AMI VSD and severe refractory cardiogenic shock who received pVAD support at our institution. Three patients underwent immediate surgical repair and received pVAD support for postcardiotomy cardiogenic shock for 2, 4, and 7 days, respectively. However, all three died. The other eight patients had pVAD implanted prior to surgical repair in order to rest the myocardium before operation. Hemodynamics improved immediately after pVAD placement, and after receiving pVAD support for 7 ± 3 days, they underwent surgical VSD repair. Their total pre- and post-surgical pVAD support was 14 ± 4 days. All eight survived 30 days postoperatively. At 6 months postsurgery overall survival rate was 75%. Our small series of these critically ill patients shows a trend toward better survival after immediate pVAD placement to stabilize the patient and allow for myocardial maturation before surgical VSD repair.