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Multicenter Study
. 2025 Mar 18;29(1):119.
doi: 10.1186/s13054-025-05321-x.

ICU mortality of post-myocardial infarction ventricular septal defect complicated by cardiogenic shock: a retrospective multicentric cohort

Levi-Dan Azoulay #  1   2 , François Bagate #  3   4   5 , Clément Delmas  6 , Sylvie Paulus  7 , Nicolas Mongardon  8   9   10 , Osama Abou-Arab  11 , Pierre Squara  12 , Michel Habis  13 , Hélène Nougue  14   15 , Tristan Morichau-Beauchant  16 , Antoine Kimmoun  17 , Aurélien Seemann  18 , Costin Radu  19 , Quentin de Roux  8   9   10 , Henri Treille de Grandsaigne  6 , Jean-Luc Fellahi  7 , Christophe Beyls  11 , Bernard Cholley  14   20 , Thomas Klein  16 , Antoine Gaillet  1   2   21 , Armand Mekontso Dessap  1   2   21 ; French PMI-VSD-Shock Study Group (FPSG)
Collaborators, Affiliations
Multicenter Study

ICU mortality of post-myocardial infarction ventricular septal defect complicated by cardiogenic shock: a retrospective multicentric cohort

Levi-Dan Azoulay et al. Crit Care. .

Abstract

Purpose: Post myocardial infarction ventricular septal defect (PMI-VSD) complicated by refractory cardiogenic shock is associated with an extremely high mortality rate. We sought to evaluate the factors associated with in-ICU mortality in patients with PMI-VSD-related cardiogenic shock.

Methods: Patients with PMI-VSD complicated by cardiogenic shock, admitted in 10 French tertiary centers between 2008 and 2022, were retrospectively included. The primary outcome was in-ICU mortality. The timing of surgery was classified as early (≤ 7 days) or late (> 7 days). Multivariable analysis was performed to identify the variables associated with in-ICU mortality.

Results: A total of 138 patients were included (mean age 70 (± 10) years, female sex 54%). Of these, 116 patients (84%) received MCS, including 43 patients (31%) with VA-ECMO. VSD surgical closure was performed in 93 patients (67%, 60 early, 33 late). Only 2 patients had percutaneous closure without surgical repair. A total of 84 patients (61%) died. The type of surgical management strategy was significantly associated with in-ICU mortality (no surgery, 100%; early surgery, 45%; late surgery, 27%; ptrend < 0.001). In all patients, the variables independently associated with in-ICU mortality were: old age (adjusted OR = 1.1, 95%CI [1.02-1.12.], p = 0.004), SOFA score (adjusted OR = 1.2, 95%CI [1.07.-1.37], p = 0.003), and VA-ECMO (adjusted OR = 2.9, 95%CI [1.2-7.7], p = 0.02). In patients with VSD surgical closure, a longer delay between ICU admission and VSD surgical closure was independently associated with decreased in-ICU mortality (adjusted OR = 0.9, 95%CI [0.79-0.96], p = 0.003).

Conclusion: Delayed VSD closure is associated with improved outcomes in PMI-VSD complicated by cardiogenic shock.

Trial registration: #CE SRLF 19-34, #CNIL MR004 2224973, retrospectively registered 04 July 2019.

Keywords: Cardiogenic shock; Extra corporeal membrane oxygenation; Mechanical circulatory support; Mechanical complication; Myocardial infarction; Surgical timing; Ventricular septal defect.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by our Institutional Review Board (Ethics committee of the French Intensive Care Society (SRLF) CE SRLF 19–34) and was conducted in accordance with the French Data Protection Authority (CNIL MR004 2224973) and with the Declaration of Helsinki. Written consent was not required due to the retrospective nature of the study. Consent for publication: Written consent was not required due to the retrospective nature of the study. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study Flow Chart. Abbreviations: VA-ECMO veno-arterial extracorporeal membrane oxygenation; ICU intensive care unit; PMI post-myocardial infarction; VSD ventricular septal defect
Fig. 2
Fig. 2
In-ICU death according to surgery strategy and delay. A. In all patients. B. In VA-ECMO implanted patients. Abbreviations: VA-ECMO, veno-arterial extracorporeal membrane oxygenation; ICU, intensive care unit
See this image and copyright information in PMC

References

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