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Case report
Michael G Katz
Icahn School of Medicine at Mount Sinai
Corresponding Author
ORCiD: https://orcid.org/0000-0003-4614-1485
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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.
Keywords
Ventricular septal defect, Impella 5.5 SmartAssist, acute myocardial infarction, cardiogenic shock
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CURRENT STATUS: Under Review
Version 1
Posted 05 Aug, 2020
No community comments so far
Editorial decision: Major revision
On 10 Apr, 2021
Review #3 received
Received 09 Apr, 2021
Review #2 received
Received 05 Apr, 2021
Review #1 received
Received 05 Apr, 2021
Reviewer #3 agreed
On 25 Mar, 2021
Reviewer #2 agreed
On 22 Mar, 2021
Reviewer #1 agreed
On 23 Dec, 2020
Reviewers invited
Invitations sent on 06 Aug, 2020
First submitted
On 03 Aug, 2020
Editor assigned
On 03 Aug, 2020
Submission checks complete
On 02 Aug, 2020
Editor invited
On 02 Aug, 2020
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Subject Areas
Cardiothoracic Surgery
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This preprint is under consideration at Journal of Cardiothoracic Surgery. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Case report
Michael G Katz
Icahn School of Medicine at Mount Sinai
Corresponding Author
ORCiD: https://orcid.org/0000-0003-4614-1485
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 05 Aug, 2020
No community comments so far
Editorial decision: Major revision
On 10 Apr, 2021
Review #3 received
Received 09 Apr, 2021
Review #2 received
Received 05 Apr, 2021
Review #1 received
Received 05 Apr, 2021
Reviewer #3 agreed
On 25 Mar, 2021
Reviewer #2 agreed
On 22 Mar, 2021
Reviewer #1 agreed
On 23 Dec, 2020
Reviewers invited
Invitations sent on 06 Aug, 2020
First submitted
On 03 Aug, 2020
Editor assigned
On 03 Aug, 2020
Submission checks complete
On 02 Aug, 2020
Editor invited
On 02 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Cardiothoracic Surgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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.
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
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