Preoperative Use of Venoarterial Extracorporeal Membrane Oxygenation in Postinfarct Ventricular Septal Rupture: Insights From the Extracorporeal Life Support Organization Registry
Year: 2026
Type: article
Study design: Observational Study
Abstract: Ventricular septal rupture (VSR) is a rare but often fatal complication of acute myocardial infarction (AMI), with a high mortality largely driven by resultant cardiogenic shock. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides emergency circulatory support and may improve outcomes. We retrospectively analyzed the Extracorporeal Life Support Organization (ELSO) Registry to identify adults (≥18 years) with post-AMI VSR receiving preoperative VA-ECMO (2000-2025). Clinical characteristics were compared between survivors and nonsurvivors. The primary outcome was in-hospital survival. Among 370 patients, the median age was 66 years, 70% were male, and 66% were in cardiogenic shock at ECMO initiation. Inferior AMI occurred in 56%, and 56% had prior mechanical circulatory support. In-hospital mortality was 68%. Survivors were significantly younger (median 62 vs . 67 years) and had lower rates of pre-ECMO cardiac arrest (7% vs . 21%), tamponade (2% vs . 8%), and renal replacement therapy (21% vs . 37%). Survivors also experienced longer duration of ECMO support and hospital length of stay. While rescuing many patients in post-AMI VSR-related shock, mortality remains high. Identifying predictors of survival and optimizing perioperative management are essential to improve outcomes in this high-risk group.
Source: ASAIO Journal
Authors: Marco Gemelli, Daniele Ronco, Matteo Matteucci, Giulio Massimi, Michele Di Mauro, Graeme MacLaren, Giles J. Peek, Navin K. Kapur, Louis H. Stein, Scott Silvestry, Daniel Goldstein, Rakesh C. Arora, Glenn Whitman, Daniel T. Engelman, Xin Li, Hiroo Takayama, Daniel Brodie, Xiaotong Hou, Gino Gerosa, Albert Ariza-Solè, Roberto Lorusso
Institutions: Tufts Medical Center, UF Health Shands Hospital, University of Florida Health, University of Florida, National University Hospital, National University Health System, Newark Beth Israel Medical Center, University of Arizona, Maastricht University Medical Centre, University of Foggia, Johns Hopkins University, Johns Hopkins Hospital, Baystate Health, Fudan University, Zhongshan Hospital, Columbia University, Johns Hopkins Medicine, University of Padua, Azienda Ospedale - Università Padova, Bellvitge University Hospital
Language: English
Subfield: Biomedical Engineering
Field: Engineering
Domain: Physical Sciences
Open Access status: hybrid
OpenAlex ID: W7154356556