Posterior Ventricular Septal Defect in Presence of Cardiogenic Shock Early Implantation of the Impella Recover LP 5.0 as a Bridge to Surgery

Urgent repair (within 48 hr after diagnosis) of posterior ventricular septal defect in the presence of cardiogenic shock, consequent to acute myocardial infarction, is associated with a very high mortality rate. The use of left ventricular mechanical support devices has the potential to impart hemodynamic stability and to delay surgical treatment until such time as scar tissue forms around the defect, sufficient to hold a suture patch. From May 2004 through July 2007, 5 patients who were in cardiogenic shock as a consequence of acute posterior ventricular septal defect underwent early implantation of a transfemoral microaxial Impella (R) Recover (R) LP 5.0 Support System as mechanical support (bridge to surgery). The mean duration of support by the left ventricular assist device was 14.4 +/- 6 days. No one died during assistance. The device reduced left-to-right shunting, systolic pulmonary artery pressure, central venous pressure, and pulmonary capillary wedge pressure. Liver, kidney, and lung function improved, and the 30-day mortality rate was 40%. Although this is a retrospective study of a very small patient population, without benefit of a control group, it is the first report of its kind. This initial experience using the Impella Recover 5.0 in cases of cardiogenic shock due to posterior ventricular septal defect suggests that this conservative approach is a feasible and safe way to improve hemodynamic conditions and delay surgery. Further clinical experience is needed to confirm these early results. (Tex Heart Inst J 2011;38(1):42-9)