Impella 5.5 Support for Delayed Surgical Ventricular Septal Defect Repair—A Paradigm Shift?

Abstract

Background Ventricular septal defects (VSDs) remain a rare but life-threatening complication of myocardial infarction. Although the incidence has decreased due to better treatment options, the mortality rate remains high. The timing of VSD repair remains critical to outcome. The use of mechanical circulatory support is rarely described in the literature, although it may help to delay repair to allow tissue stabilization. While Impella is currently considered contraindicated due to the potential worsening of the right-to-left shunt and possible systemic embolization of necrotic debris, there is no comprehensive evidence for this. Therefore, we aimed to analyze whether the use of Impella 5.5 as a first choice for patients undergoing VSD repair should be considered for discussion.

Methods This retrospective study analyses four consecutive patients who underwent delayed ventricular septal repair after prior implantation of Impella 5.5 (Abiomed Inc., Danvers, Massachusetts, United States).

Results A total of 75% of patients (n = 3) presented with acute right heart failure prior to implantation with a mean systolic pulmonary artery pressure of 64 ± 3.0 mmHg. Implantation was performed under local anesthesia in three cases. The mean time to surgery was 9.8 ± 3.1 days. All patients remained on the Impella 5.5 device postoperatively. Weaning from Impella 5.5 was successful in 75% (n = 3). The mean length of stay in the intensive care unit was 22.3 ± 7.5 days.

Conclusion Preoperative implantation of the Impella 5.5 device is a safe and feasible option for patients undergoing VSD repair. Outcomes may be improved by performing Impella implantation under local anesthesia and continuing Impella support after VSD repair. However, it is important to note that these patients represent a high-risk cohort and the mortality rate remains high.

Keywords

circulatory support - ventricular septal defect - myocardial infarction - outcomes - surgery

Authors' Contribution

Conception and design: K.E., I.D., E.W.K., F.B., A.C.D., T.C.W.W. Data collection: K.E., C.G., I.K., I.D., E.W.K., C.O.R. Analysis and data interpretation: K.E., C.G., I.K., C.O.R., F.B., A.C.D., T.C.W.W. Statistical analysis: C.G., I.K., I.D., E.W.K., C.O.R. Drafting of the manuscript: C.G., K.E., E.W.K., A.C.D., T.C.W.W. Critical revision of the article: K.E., F.B., N.M., A.C.D., T.C.W.W.

^* These authors contributed equally to this work.

^** These authors share first authorship.

^*** These authors share senior authorship.

Publication History

Received: 27 March 2024

Accepted: 19 July 2024

Article published online:
12 August 2024

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