Does extracorporeal life support influence outcome after surgical management of post infarct ventricular septal rupture? A monocenter retrospective study

BACKGROUND: Ventricular septal rupture (VSR) is an uncommon but life-threatening complication of acute myocardial infarction. Extra corporeal life support (ECLS) use in the preoperative setting allows hemodynamic stabilization for a delayed surgery. We aimed to assess the role of ECLS in the preoperative period of post infarction VSR surgery.METHODS: We retrospectively analyzed all consecutive patients operated for VSR between January 2007 and August 2019. We assessed base-line characteristics, pre and post-operative clinical status and the use of ECLS in the peri-operative period.RESULTS: A total of 39 patients were included. Mean age was 69.8 years. In-hospital mortality was 48.7%. Survivors and non-survivor patients had similar characteristics except for lower postoperative ejection fraction (32% vs. 42%, P=0.02) and more acute renal failure (71.4% vs. 10%, P=0.0005) in the non-survivor group. Patients who received ECLS preoperatively were younger (72 vs. 65, P=0.02) and had more preoperative invasive ventilation (16% vs. 50%, P=0.04). Cardiopulmonary bypass (CPB, 140 min vs. 75 min, P=0.0008) and cross clamping times (94 min vs. 52 min, P=0.0026) were significantly higher in the ECLS group. There were more bleeding complications in the ECMO group (45.4% vs. 0%, P=0.0019) and more need for reintervention (63.3% vs. 13%, P=0.015). There was no difference in mortality between the two groups. There was no difference in postoperative characteristics between urgent and delayed surgery.CONCLUSIONS: In our study, post-operative ECLS use was associated with more bleeding complications and need for reintervention. Al-though mortality was similar, bleeding complications remain a major limitation for the systematic use of ECLS in the post-operative period.(Cite this article as: Fikani A, Beaufigeau M, Vignon J, Cosset B, Hayek A, Farhat F. Does extracorporeal life support influence outcome after surgical management of post infarct ventricular septal rupture? A monocenter retrospective study. J Cardiovasc Surg 2023;64:224-9. DOI: 10.23736/S0021-

Automated summary

This retrospective study analyzed consecutive patients who underwent surgery for VSR and found that post-operative use of ECLS was associated with more bleeding complications and the need for reintervention. Although mortality was similar, bleeding complications remain a major limitation for the use of ECLS.