Advantages of Surgical Implantation Impella 5.5 SmartAssist in the Management of Acute Post-Infarction Ventricular Septal Defect with Cardiogenic Shock

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Abstract ABSTRACT Background: Despite advances in surgical techniques and aggressive therapy of post-infarction ventricular septal defect (VSD) with cardiogenic shock, the overall morbidity and mortality is frustratingly high. The Impella 5.5 SmartAssist (Abiomed, Danvers, MA) is a surgically implanted temporary device, recently approved by the FDA for treatment of patients in cardiogenic shock, and may fill a technological gap for perioperative patients who require acute circulatory support. Case presentation: We report our initial experience with trans-aortic implantation of the Impella 5.5 SmartAssist for two patients with post myocardial infarction VSD in the setting of cardiogenic shock. First patient had a posterior VSD with a left to right shunt (Qp/Qs ratio of 3.3), right ventricle dysfunction, severe pulmonary arterial hypertension, and severe mitral valve regurgitation. Second patient was admitted for massive MI with large anterior VSD (Qp/Qs ratio of 2.8). Under cardiopulmonary bypass with cardioplegic arrest both patients underwent urgent VSD closure with trans-aortic implantation of the Impella. Minimal postoperative support was required. Patients were discharged on postoperative day 10 and 14 and remained well three months later. Follow-up echocardiogram showed no residual shunt. Conclusions: Early surgical implantation of Impella 5.5 SmartAssist can prevent multiorgan dysfunction and stabilize the patients in cardiogenic shock with post-myocardial infarction VSD.

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