Outcomes for Patients with Post-Infarction Ventricular Septal Defect with and without Impella 5.5 Bridging

10159 

Abstract Submission 

Sarah Madira (1), Sophia Roberts (2), Aaron Guo (3), Takuya Wada (4), Kunal Kotkar (5), Muhammad Masood (6), Ralph Damiano (7), Tsuyoshi Kaneko (8), John Lasala (9), Amit Pawale (10)

(1) N/A, St Louis, MO, (2) Barnes Jewish Hospital, St. Louis, MO, (3) Washington University School of Medicine in St. Louis, St. Louis, MO, (4) Akita University Hospital, Akita, Akita, (5) Barnes Jewish hospital, St. Louis, MO, (6) Barnes Jewish Hospital, Saint Louis, MO, (7) Washington University - St. Louis, St. Louis, MO, (8) Washington University, St. Louis, MO, (9) Washington University in St Louis School of Medicine, St Louis, MO, (10) Washington University in St Louis, St Louis, MO

Sarah Madira    -  Contact Me
N/A

Sophia Roberts    -  Contact Me
Barnes Jewish Hospital

Aaron Guo    -  Contact Me
Washington University School of Medicine in St. Louis

Takuya Wada    -  Contact Me
Akita University Hospital

Kunal Kotkar    -  Contact Me
Barnes Jewish hospital

Muhammad Masood    -  Contact Me
Barnes Jewish Hospital

*Ralph Damiano    -  Contact Me
Washington University - St. Louis

*Tsuyoshi Kaneko    -  Contact Me
Washington University

John Lasala    -  Contact Me
Washington University in St Louis School of Medicine

*Amit Pawale    -  Contact Me
Washington University in St Louis

Sarah Madira    -  Contact Me
N/A

Objective: To compare outcomes for patients with post-infarction ventricular septal defect (VSD) with and without Impella 5.5 bridging.

Methods: We retrospectively reviewed 34 patients who were admitted to our institution with post-infarction VSD from January 2018 to June 2024. Patients who had a history of previous or recent cardiac surgery or chronic VSD were excluded (n=4). One patient was excluded for receiving axillary Impella CP support due to a small axillary artery. Axillary artery Impella 5.5 was first used as bridge therapy for post-infarction VSD at our institution in May 2022, and employed thereafter for this indication based on surgeon preference. We compared patients with post-infarct VSD who received Impella 5.5 as a bridge to VSD closure or palliation to those who did not. Primary outcomes were survival at 30-days and hospital discharge. Categorical variables were compared using Fisher's exact test and continuous variables were compared using Mann Whitney U test.

Results: Of the 29 patients included, 10 received Impella 5.5 support and 19 did not receive Impella 5.5 support. Baseline characteristics were similar between groups. Of the Impella 5.5 group, prior to receiving Impella 5.5 support, 1 patient received venoarterial (VA) ECMO, 3 patients received Impella CP, and 2 patients received IABP support. Among the patients who did not receive Impella 5.5 support, prior to VSD closure, 3 patients received VA ECMO, 3 patients received Impella CP, and 12 patients received IABP support. Three patients had failure of percutaneous VSD closure, then underwent subsequent surgical VSD closure. One patient in the Impella 5.5 group received concomitant Heartmate 3 left ventricular assist device support along with surgical VSD closure. Among the patients bridged to surgical repair with Impella 5.5, 4 out of 5 underwent Impella 5.5 removal at the time of surgical repair. Among patients who underwent surgical VSD closure, patients in the Impella 5.5 group had significantly shorter cardiopulmonary bypass times (109 vs. 183 min, P=0.05). Of patients who survived to surgical VSD closure, 100% survived to hospital discharge with preoperative Impella 5.5 support while 54.5% survived without preoperative Impella 5.5 support.

Conclusions:
Impella 5.5 bridging to surgical VSD closure could be a viable strategy and may improve postoperative survival. It may reduce cardiopulmonary bypass time and need for postoperative VA ECMO. Limitations of this study include small sample size and potential selection bias of patients.

Heart Transplant