The role of perioperative cardiorespiratory support in post infarction ventricular septal rupture-related cardiogenic shock
| Autor: | David Toral, Eva Santafosta, Arnau Blasco-Lucas, Oriol Alegre, Victòria Lorente, José González-Costello, Fabrizio Sbraga, Albert Ariza-Solé, Daniel Ortiz, Angel Cequier, Albert Miralles, José C. Sánchez-Salado, Jacobo Toscano, Andrea Izquierdo |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Multiple Organ Failure Myocardial Infarction Shock Cardiogenic Infarction 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Perioperative Care Ventricular Function Left Ventricular Septal Rupture 03 medical and health sciences 0302 clinical medicine Extracorporeal Membrane Oxygenation Risk Factors Internal medicine medicine Extracorporeal membrane oxygenation Humans cardiovascular diseases 030212 general & internal medicine Myocardial infarction Hospital Mortality Lactic Acid Aged Retrospective Studies Aged 80 and over Ejection fraction business.industry Cardiogenic shock Alanine Transaminase Stroke Volume General Medicine Perioperative Middle Aged medicine.disease Treatment Outcome Ventricular assist device Case-Control Studies Creatinine Practice Guidelines as Topic Cardiology Female Heart-Assist Devices Cardiology and Cardiovascular Medicine business |
| Zdroj: | European heart journal. Acute cardiovascular care. 9(2) |
| ISSN: | 2048-8734 |
| Popis: | Background: Current guidelines recommend emergency surgical correction in patients with post infarction ventricular septal rupture (PIVSR), but patients with multiorgan failure are commonly managed conservatively because of high surgical risk. We assessed characteristics and outcomes of operated PIVSR patients with or without the use of short-term ventricular assist devices (ST-VADs). We also assessed the impact of a ST-VAD on the performance of surgery Methods: We retrospectively analysed all consecutive patients with PIVSR between January 2004 and May 2017. Baseline clinical characteristics, use of ST-VAD and performance of surgery during admission were assessed. The main outcome measured was in-hospital mortality. Results: A total of 28 patients were included. Mean age was 69.2 years. Most patients (20/28, 71.4%) underwent surgical repair. ST-VADs were used in 11/28 patients (39.3%). This percentage progressively increased across the study period, from 22.2% (2/9) in 2004–2011 to 58.3% (7/12) in 2015–2017 ( p=0.091). Patients undergoing ST-VAD use had poorer INTERMACS status, higher values of creatinine, lactate and alanine aminotransferase and lower left ventricular ejection fraction as compared with operated patients without support. In-hospital mortality did not differ according to the use of ST-VADs in operated patients (27.3% without ST-VAD vs. 22.2% with ST-VAD, p=0.604). All five patients undergoing early preoperative venoarterial extracorporeal membrane oxygenator support and delayed surgery survived at hospital discharge. Conclusions: ST-VAD use increased in patients with PIVSR. Despite a higher risk profile in operated patients undergoing ST-VAD use, mortality was not significantly different in these patients. Early preoperative venoarterial extracorporeal membrane oxygenation should be considered for very high risk PIVSR patients. |
| Databáze: | OpenAIRE |
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