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

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).

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

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

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