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. 2023 Sep 22;3(5):oead091.
doi: 10.1093/ehjopen/oead091. eCollection 2023 Sep.

The current clinical practice for management of post-infarction ventricular septal rupture: a European survey

Daniele Ronco  1   2   3 , Albert Ariza-Solé  4 , Mariusz Kowalewski  2   3   5 , Matteo Matteucci  2   3   6 , Michele Di Mauro  2 , Esteban López-de-Sá  7 , Marco Ranucci  8 , Alessandro Sionis  9   10 , Nikolaos Bonaros  11 , Michele De Bonis  12 , Claudio Francesco Russo  13 , Aitor Uribarri  10   14 , Santiago Montero  15 , Theodor Fischlein  16 , Adam Kowalówka  17 , Shiho Naito  18 , Jean-François Obadia  19 , Roberto Martín-Asenjo  20 , Jaime Aboal  21 , Matthias Thielmann  22 , Caterina Simon  23 , Rut Andrea-Riba  24 , Carolina Parra  25 , Thierry Folliguet  26 , Manuel Martínez-Sellés  27 , Marcelo Sanmartín Fernández  28 , Nawwar Al-Attar  29 , Ana Viana Tejedor  30 , Giuseppe Filiberto Serraino  31 , Virginia Burgos Palacios  32 , Udo Boeken  33 , Sergio Raposeiras Roubin  34 , Miguel Antonio Solla Buceta  35 , Pedro Luis Sánchez Fernández  36 , Roberto Scrofani  37 , Gemma Pastor Báez  14 , Pablo Jorge Pérez  38 , Guglielmo Actis Dato  39 , Juan Carlos Garcia-Rubira  40 , Jose H de Gea Garcia  41 , Giulio Massimi  2   3 , Andrea Musazzi  6 , Roberto Lorusso  2   42
Affiliations

The current clinical practice for management of post-infarction ventricular septal rupture: a European survey

Daniele Ronco et al. Eur Heart J Open. .

Abstract

Aims: Many historical and recent reports showed that post-infarction ventricular septal rupture (VSR) represents a life-threatening condition and the strategy to optimally manage it remains undefined. Therefore, disparate treatment policies among different centres with variable results are often described. We analysed data from European centres to capture the current clinical practice in VSR management.

Methods and results: Thirty-nine centres belonging to eight European countries participated in a survey, filling a digital form of 38 questions from April to October 2022, to collect information about all the aspects of VSR treatment. Most centres encounter 1-5 VSR cases/year. Surgery remains the treatment of choice over percutaneous closure (71.8% vs. 28.2%). A delayed repair represents the preferred approach (87.2%). Haemodynamic conditions influence the management in almost all centres, although some try to achieve patients stabilization and delayed surgery even in cardiogenic shock. Although 33.3% of centres do not perform coronarography in unstable patients, revascularization approaches are widely variable. Most centres adopt mechanical circulatory support (MCS), mostly extracorporeal membrane oxygenation, especially pre-operatively to stabilize patients and achieve delayed repair. Post-operatively, such MCS are more often adopted in patients with ventricular dysfunction.

Conclusion: In real-life, delayed surgery, regardless of the haemodynamic conditions, is the preferred strategy for VSR management in Europe. Extracorporeal membrane oxygenation is becoming the most frequently adopted MCS as bridge-to-operation. This survey provides a useful background to develop dedicated, prospective studies to strengthen the current evidence on VSR treatment and to help improving its currently unsatisfactory outcomes.

Keywords: Acute myocardial infarction; Cardiogenic shock; Extracorporeal membrane oxygenation; Mechanical circulatory support; Mechanical complication; Ventricular septal rupture.

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Conflict of interest statement

Conflict of interest: N.B. received speaker’s honoraria from Edwards Lifesciences and Medtronic, and educational grant from Edwards Lifesciences and Corcym. T.F. is consultant for LivaNova and BioStable. J.F.O. is consultant for Abbott, Delacroix-Chevalier, Landanger, and Medtronic. R.L. is Principal Investigator of the PERSIST-AVR Study sponsored by LivaNova, and is consultant for Medtronic, LivaNova, and Eurosets (all honoraria paid to the university). The remaining authors have nothing to disclose.

Figures

Graphical abstract
Graphical abstract
First-line approach for management of post-acute myocardial infarction ventricular septal rupture according to interviewed centres.
Figure 1
Figure 1
Distribution of European centres participating to the survey.
Figure 2
Figure 2
(A) Preferred approach for coronary revascularization. (B) Pre-operative MCS of choice. (C) Post-operative MCS of choice. (D) MCS for isolated right ventricular failure. Numbers and percentages of interviewed centres are presented. CABG, coronary artery bypass grafting; PCI, percutaneous coronary intervention; POBA, plain old balloon angioplasty; RVAD, right ventricular assist device; VA-ECMO, veno-arterial extracorporeal membrane oxygenation; VSR, ventricular septal rupture; IABP, intra-aortic balloon pump.
See this image and copyright information in PMC

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