Review of management of post-infarction ventricular septal rupture in the era of mechanical circulatory support: Optimal timing for surgical correction

The optimal timing of corrective surgery in post-infarction ventricular septal defect (VSD) is still a matter of debate among the scientific community. The purpose of this article is to review the most relevant publications in the last 5 years on the implementation of mechanical circulatory support (MCS) devices as a bridge to surgical repair in patients with a post-infarction VSD. For patients who are in cardiogenic shock as a result of a VSD, the current trend is the use of MCS as a bridge to surgery, either in an isolated (VA-ECMO or Impella) or combined (VA-ECMO + Impella or VA-ECMO + vent drainage in left ventricle) manner. Corrective surgery will be performed when the hemodynamics are favorable, the tissue has healed and is adequately enough to support stitches. The main factor that determines survival after VSD is the timing of the surgery. Therefore, most centers tend to postpone corrective surgery whenever possible. There is a growing tendency to implant MCS devices in patients in cardiogenic shock as a bridge to surgical correction, with results likely superior to those of emergent surgery. Although the results are encouraging, the mortality rate in this profile of patients remains very high (over 40%). (C) 2020 Sociedad Espanola de Cirugia Cardiovascular y Endovascular. Published by Elsevier Espana, S.L.U.