Trends and Outcomes of Mechanical Support Use in Surgical Repair of Ventricular Septal Defect after Myocardial Infarction

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Ventricular septal defect after myocardial infarction (MI-VSD) is a rare but fatal complication. This real-world database study reports the patient characteristics and outcomes after surgical repair of MI-VSD based on the Japanese Registry of All Cardiac and Vascular Diseases Diagnosis Procedure Combination (JROAD-DPC), especially considering the popularity of percutaneous ventricular assist device (PVAD) use.This retrospective study used data from the JROAD-DPC, a nationwide administrative claims database in Japan, covering the period from April 2012 to March 2022. In the JROAD-DPC database, among 487,178 patients with acute myocardial infarction across 1,124 institutions, the present study analyzed 1,763 patients (49.7% female, 74.8 ± 9.1 years old) who underwent surgical repair of MI-VSD, with in-hospital death as the primary outcome.More than 60% of the patients were Killip III or IV, and most were receiving inotropes. Perioperatively, 87.4%, 13.2%, and 4.7% received support with an intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO), and PVAD, respectively. ECMO and PVAD were used in combination in 15 patients. The time from device placement to surgical repair tended to be longer in patients using PVAD. Since 2018, the number of cases using PVAD in the perioperative period has increased, but the in-hospital mortality consistently exceeds 30% with no improvement in prognosis. Furthermore, there was a significant trend toward increased perioperative bleeding.PVAD are still used infrequently and the mortality rate of MI-VSD remains significantly high.

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