Impact of mechanical support with the impella for ventricular septal rupture

OBJECTIVES: Ventricular septal rupture is a rare but fatal complication of acute myocardial infarction. Although mechanical circulatory support is increasingly being used to stabilize the hemodynamics in such cases, its definitive clinical benefit remains unclear. Delayed surgical intervention after achieving hemodynamic stabilization with mechanical circulatory support is considered to offer better outcomes than emergency surgery. This study aimed to evaluate the efficacy of using the Impella device (Abiomed, Danvers, MA, USA) as a bridge to surgical repair in patients with post-infarction ventricular septal rupture. METHODS: We retrospectively analyzed 12 patients who underwent surgical ventricular septal rupture closure under perioperative Impella support between October 2022 and June 2025 at our institution. RESULTS: The 30-day mortality was 8% (1/12 patients). The mean duration from admission to surgery was 64 ± 35 h (range 2-118 h). Preoperatively, inhaled nitric oxide (NO) was administered to nine patients (75%). The mean serum lactate concentration was 24.9 mg/dL at presentation and improved to 10.2 mg/dL at the time of surgery (p=0.001). One device-related complication was observed. A residual shunt was present in four patients (33%), one of whom required reoperation. CONCLUSIONS: Our findings demonstrated favorable early outcomes with a 30-day mortality of 8%. Impella support facilitated preoperative optimization of the systemic condition and enabled a safe transition to definitive surgical repair. Further investigations are warranted to refine the optimal timing of surgery and to assess long-term outcomes in this challenging population of patients with ventricular septal rupture.