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Review
. 2022 May;11(3):304-309.
doi: 10.21037/acs-2021-ami-206.

Pre- and post-operative mechanical circulatory support in surgical repair of post-acute myocardial infarction mechanical complications

Anju Bhardwaj  1 , Sachin Kumar  1 , Ismael A Salas de Armas  1 , Angelo Nascimbene  1 , Sriram Nathan  1 , Biswajit Kar  1 , Igor D Gregoric  1
Affiliations
Review

Pre- and post-operative mechanical circulatory support in surgical repair of post-acute myocardial infarction mechanical complications

Anju Bhardwaj et al. Ann Cardiothorac Surg. 2022 May.

Abstract

The outcomes of patients with acute myocardial infarctions (AMI) have significantly improved with advances in early reperfusion strategies; however, patients with massive infarcts or those who do not receive timely revascularization may develop mechanical complications of AMI. The most common mechanical complications are ventricular septal rupture (VSR), acute mitral regurgitation (MR) due to papillary muscle rupture, and free-wall rupture. Each complication is associated with a high risk of morbidity and mortality, and requires a multidisciplinary approach for prompt diagnosis and hemodynamic stabilization. Surgery is the mainstay of therapy but is associated with poor outcomes if performed too early during the treatment course for VSR or if performed too late with MR and free wall rupture. Optimal timing for surgery in combination with temporary circulatory support may be a feasible strategy for better results.

Keywords: Mechanical circulatory support (MCS); left ventricular assist device; mechanical complication; ventricular septal rupture (VSR).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Visualization of apical ventricular septal rupture (A) and surgical patch repair of ventricular septal rupture on a patient supported with TandemHeart (B).
Figure 2
Figure 2
Algorithm for management of post-acute myocardial infarction ventricular septal rupture. AMI, acute myocardial infarction; VSR, ventricular septal rupture; IABP, intra-aortic balloon pump; perc, percutaneous; TAH, total artificial heart.
Video
Video
Pre- and post-operative mechanical circulatory support in surgical repair of post-acute myocardial infarction mechanical complications.
See this image and copyright information in PMC

References

    1. Damluji AA, van Diepen S, Katz JN, et al. Mechanical Complications of Acute Myocardial Infarction: A Scientific Statement From the American Heart Association. Circulation 2021;144:e16-35. 10.1161/CIR.0000000000000985 - DOI - PMC - PubMed
    1. Elbadawi A, Elgendy IY, Mahmoud K, et al. Temporal Trends and Outcomes of Mechanical Complications in Patients With Acute Myocardial Infarction. JACC Cardiovasc Interv 2019;12:1825-36. 10.1016/j.jcin.2019.04.039 - DOI - PubMed
    1. Jones BM, Kapadia SR, Smedira NG, et al. Ventricular septal rupture complicating acute myocardial infarction: a contemporary review. Eur Heart J 2014;35:2060-8. 10.1093/eurheartj/ehu248 - DOI - PubMed
    1. Papalexopoulou N, Young CP, Attia RQ. What is the best timing of surgery in patients with post-infarct ventricular septal rupture? Interact Cardiovasc Thorac Surg 2013;16:193-6. 10.1093/icvts/ivs444 - DOI - PMC - PubMed
    1. Pahuja M, Schrage B, Westermann D, et al. Hemodynamic Effects of Mechanical Circulatory Support Devices in Ventricular Septal Defect. Circ Heart Fail 2019;12:e005981. 10.1161/CIRCHEARTFAILURE.119.005981 - DOI - PubMed