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%; p(trend) < 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.