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

TY - JOUR

T1 - The current clinical practice for management of post-infarction ventricular septal rupture: a European survey

AU - Ronco, Daniele

AU - Ariza-Solé, Albert

AU - Kowalewski, Mariusz

AU - Matteucci, Matteo

AU - Di Mauro, Michele

AU - López-de-Sá, Esteban

AU - Ranucci, Marco

AU - Sionis, Alessandro

AU - Bonaros, Nikolaos

AU - De Bonis, Michele

AU - Russo, Claudio Francesco

AU - Uribarri, Aitor

AU - Montero, Santiago

AU - Fischlein, Theodor

AU - Kowalówka, Adam

AU - Naito, Shiho

AU - Obadia, Jean-François

AU - Martín-Asenjo, Roberto

AU - Aboal, Jaime

AU - Thielmann, Matthias

AU - Simon, Caterina

AU - Andrea-Riba, Rut

AU - Parra, Carolina

AU - Folliguet, Thierry

AU - Martínez-Sellés, Manuel

AU - Sanmartín Fernández, Marcelo

AU - Al-Attar, Nawwar

AU - Viana Tejedor, Ana

AU - Serraino, Giuseppe Filiberto

AU - Burgos Palacios, Virginia

AU - Boeken, Udo

AU - Raposeiras Roubin, Sergio

AU - Solla Buceta, Miguel Antonio

AU - Sánchez Fernández, Pedro Luis

AU - Scrofani, Roberto

AU - Pastor Báez, Gemma

AU - Jorge Pérez, Pablo

AU - Actis Dato, Guglielmo

AU - Garcia-Rubira, Juan Carlos

AU - de Gea Garcia, Jose H

AU - Massimi, Giulio

AU - Musazzi, Andrea

AU - Lorusso, Roberto

N1 - © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.

PY - 2023/9

Y1 - 2023/9

N2 - 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.

AB - 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.

U2 - 10.1093/ehjopen/oead091

DO - 10.1093/ehjopen/oead091

M3 - SCORING: Journal article

C2 - 37840585

VL - 3

SP - oead091

JO - European heart journal open

JF - European heart journal open

SN - 2752-4191

IS - 5

ER -