PMID- 28470920 OWN - NLM STAT- MEDLINE DCOM- 20180305 LR - 20180402 IS - 1879-0844 (Electronic) IS - 1388-9842 (Linking) VI - 19 Suppl 2 DP - 2017 May TI - A rationale for early extracorporeal membrane oxygenation in patients with postinfarction ventricular septal rupture complicated by cardiogenic shock. PG - 97-103 LID - 10.1002/ejhf.852 [doi] AB - AIMS: Ventricular septal rupture (VSR) became a rare mechanical complication of myocardial infarction in the era of percutaneous coronary interventions but is associated with extreme mortality in patients who present with cardiogenic shock (CS). Promising outcomes have been reported with the use of circulatory support allowing haemodynamic stabilization, followed by delayed repair. Therefore, we analysed our experience with an early use of Veno-Arterial Extracorporeal Membrane Oxygenation (V-A ECMO) for postinfarction VSR. METHODS AND RESULTS: We conducted a retrospective search of institutional database for patients presenting with postinfarction VSR from January 2007 to June 2016. Data from 31 consecutive patients (mean age 69.5 +/- 9.1 years) who were admitted to hospital were analysed. Seven out of 31 patients with VSR who were in refractory CS received V-A ECMO support preoperatively. ECMO improved end-organ perfusion with decreased lactate levels 24 hours after implantation (7.9 mmol/L vs. 1.6 mmol/L, p = 0.01), normalized arterial pH (7.25 vs. 7.40, p < 0.04), improved mean arterial pressure (64 mmHg vs. 83 mmHg, p < 0.01) and lowered heart rate (115/min vs. 68/min, p < 0.01). Mean duration of ECMO support was 12 days, 5 out of 7 patients underwent surgical repair, 4 were weaned from ECMO, 3 survived 30 days and 2 survived more than 1 year. The most frequent complication (5 patients) and the cause of death (3 patients) was bleeding. CONCLUSIONS: Our experience suggests that early V-A ECMO in patients with VSR and refractory CS might prevent irreversible multiorgan failure by improved end-organ perfusion. Bleeding complications remain an important limitation of this approach. CI - (c) 2017 The Authors. European Journal of Heart Failure (c) 2017 European Society of Cardiology. FAU - Rob, Daniel AU - Rob D AD - 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. FAU - Spunda, Rudolf AU - Spunda R AD - 2nd Surgery Department - Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. FAU - Lindner, Jaroslav AU - Lindner J AD - 2nd Surgery Department - Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. FAU - Rohn, Vilem AU - Rohn V AD - Cardiovascular Surgery Department, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic. FAU - Kunstyr, Jan AU - Kunstyr J AD - Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. FAU - Balik, Martin AU - Balik M AD - Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. FAU - Rulisek, Jan AU - Rulisek J AD - Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. FAU - Kopecky, Petr AU - Kopecky P AD - Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. FAU - Lips, Michal AU - Lips M AD - Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. FAU - Smid, Ondrej AU - Smid O AD - 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. FAU - Kovarnik, Tomas AU - Kovarnik T AD - 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. FAU - Mlejnsky, Frantisek AU - Mlejnsky F AD - 2nd Surgery Department - Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. FAU - Linhart, Ales AU - Linhart A AD - 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. FAU - Belohlavek, Jan AU - Belohlavek J AD - 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Eur J Heart Fail JT - European journal of heart failure JID - 100887595 SB - IM MH - Aged MH - Angiography MH - Extracorporeal Membrane Oxygenation/*methods MH - Female MH - Follow-Up Studies MH - Hemodynamics/physiology MH - Humans MH - Male MH - Retrospective Studies MH - Risk Factors MH - Shock, Cardiogenic/etiology/physiopathology/*therapy MH - Treatment Outcome MH - Ventricular Septal Rupture/*complications/diagnosis/physiopathology OTO - NOTNLM OT - Cardiogenic Shock OT - Extracorporeal Life Support OT - Extracorporeal Membrane Oxygenation OT - Myocardial Infarction OT - Ventricular Septal Defect OT - Ventricular Septal Rupture EDAT- 2017/05/05 06:00 MHDA- 2018/03/06 06:00 CRDT- 2017/05/05 06:00 PHST- 2017/05/05 06:00 [entrez] PHST- 2017/05/05 06:00 [pubmed] PHST- 2018/03/06 06:00 [medline] AID - 10.1002/ejhf.852 [doi] PST - ppublish SO - Eur J Heart Fail. 2017 May;19 Suppl 2:97-103. doi: 10.1002/ejhf.852.