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Purpose <p>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.</p> Methods <p>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&#xa0;days) or late (&gt; 7&#xa0;days). Multivariable analysis was performed to identify the variables associated with in-ICU mortality.</p> Results <p>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<sub>trend</sub> &lt; 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.], <i>p</i> = 0.004), SOFA score (adjusted OR = 1.2, 95%CI [1.07.-1.37], <i>p</i> = 0.003), and VA-ECMO (adjusted OR = 2.9, 95%CI [1.2–7.7], <i>p</i> = 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], <i>p</i> = 0.003).</p> Conclusion <p>Delayed VSD closure is associated with improved outcomes in PMI-VSD complicated by cardiogenic shock.</p> Trial registration <p>#CE SRLF 19-34, #CNIL MR004 2224973, retrospectively registered 04 July 2019</p> Graphical Abstract <p></p> <p>Abbreviations: d day; ICU intensive care unit; SOFA sequential organ failure assessment; VA-ECMO veno-arterial extracorporeal membrane oxygenation; VSD ventricular septal defect; w with.VSD repair is equivalent to VSD surgical closure and do not include the patients (n=2) who underwent percutaneous closure only. </p>

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

  • 期刊论文

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  • 发表日期：

    2025年3月18日

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  • Levi-Dan Azoulay,
  • François Bagate,
  • Clément Delmas,
  • Sylvie Paulus,
  • Nicolas Mongardon,
  • Osama Abou-Arab,
  • Pierre Squara,
  • Michel Habis,
  • Hélène Nougue,
  • Tristan Morichau-Beauchant,
  • Antoine Kimmoun,
  • Aurélien Seemann,
  • Costin Radu,
  • Quentin de Roux,
  • Henri Treille de Grandsaigne,
  • Jean-Luc Fellahi,
  • Christophe Beyls,
  • Bernard Cholley,
  • Thomas Klein,
  • Antoine Gaillet,
  • Armand Mekontso Dessap,
  • Paul Masi,
  • Thierry Folliguet,
  • Eric Bergoend,
  • Antonio Fiore,
  • Romain Gallet,
  • Madjid Boukantar,
  • Stéphane Aubert,
  • Claude Vaislic,
  • Laurent Guesnier,
  • Bruno Pouzet,
  • Christophe Kucharski,
  • Gabriel Ghorayeb,
  • Wassim Khoury,
  • Philippe Maribas,
  • Hervé Michon,
  • Hakim Haouache,
  • Bertrand Marcheix,
  • Fanny Vardon-Bounes,
  • Paul Achouh,
  • Bastien Poitier,
  • Jérôme Fichet,
  • Stéphane Thierry,
  • Fabrice Daviaud,
  • Jean-Michel Maillet,
  • Julien Nahum,
  • Mathieu Godement,
  • Nicolas Bonnet,
  • Patrick Mesnildrey,
  • Thibault Schoell,
  • Thierry Caus,
  • Léa Didier,
  • Delphine Chesnel

摘要

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

Graphical Abstract

Abbreviations: d day; ICU intensive care unit; SOFA sequential organ failure assessment; VA-ECMO veno-arterial extracorporeal membrane oxygenation; VSD ventricular septal defect; w with.VSD repair is equivalent to VSD surgical closure and do not include the patients (n=2) who underwent percutaneous closure only.