10.11589/VAD/E20206110
Loyalka, Pranav
Pranav
Loyalka
The University of Texas Health Science Center at Houston
Nascimbene, Angelo
Angelo
Nascimbene
The University of Texas Health Science Center at Houston
Nathan, Sriram S.
Sriram S.
Nathan
The University of Texas Health Science Center at Houston
Radovancevic, Rajko
Rajko
Radovancevic
The University of Texas Health Science Center at Houston
Raman, Ajay S.
Ajay S.
Raman
The University of Texas Health Science Center at Houston
Patel, Manish
Manish
Patel
The University of Texas Health Science Center at Houston
Rajagopal, Keshava
Keshava
Rajagopal
The University of Texas Health Science Center at Houston
Kar, Biswajit
Biswajit
Kar
The University of Texas Health Science Center at Houston
Gregoric, Igor D.
Igor D.
Gregoric
The University of Texas Health Science Center at Houston
Improved outcomes in the treatment of post-myocardial infarction ventricular septal defect with percutaneous TandemHeart® left ventricular mechanical circulatory support
The VAD Journal
2020
Manuscript
FOS: Medical and health sciences
FOS: Clinical medicine
2020-05-22
2020-07-07
2020-07-17
14 pages
PDF
Creative Commons Attribution 4.0 International
Background
Post-myocardial infarction (MI) ventricular septal defect (VSD) is associated with 40% - 50% of peri-procedural mortalities; however, it is amenable to catheter-based therapies. We retrospectively investigated the impact of state-of-the-art bridging percutaneous left ventricular mechanical circulatory support (MCS) using the TandemHeart® (TH) ventricular assist device (VAD) on a patient with post-MI VSD.
Results
From July 2008 to March 2014, 23 patients were referred for treatment of post-MI VSD. Initially, 18/23 patients required MCS; 12 received an intra-aortic balloon pump (IABP), while 6 received initial TH support. Seven of the IABP patients later required TH support. Catheter-based device VSD closure was performed in 18 of the patients; however, three patients required conversion to conventional open cardiac surgical repair via VSD patch closure due to failure of the catheter-based approach. Five patients with TH underwent planned open cardiac surgical repair due to an anticipated lack of suitability for catheter-based treatment. Results revealed that delayed closure after MI correlated with improved survival. Overall, 30-day and 6-month survival rates were 83% (19/23) and 70% (16/23), respectively.
Conclusions
Further, Qp/Qs ratios of <2.4 correlated with successful percutaneous VSD repair, and this assessment should be further explored as an assessment to inform clinical judgment in patients with post-MI VSD treatment.
Loyalka, et al. Improved outcomes in the treatment of post-myocardial infarction ventricular septal defect with percuraneous TandemHeart® left ventricular mechanical circulatory support. The VAD Journal. 2020; 6(1):e20206110. https://doi.org/10.11589/vad/e20206110