Transaxillary Percutaneous Ventricular Assist Device Support as Bridge-to-Surgical-Closure for Postinfarction Ventricular Septum Defect

All articles of this category (opens in new window) Background: Postinfarction ventricular septal defect (PIVSD) is an uncommon but highly lethal mechanical complication of acute myocardial infarction. In hemodynamically compromised patients with a need for urgent surgery, surgical repair is associated with sobering results due to the friable necrotic myocardium. Temporary mechanical circulatory support devices may stabilize the circulation and postpone urgent surgery, allowing necessary tissue remodeling. The role of transaxillary percutaneous ventricular assist device (pVAD) as a routine bridge-to-closure strategy in PIVSD remains uncertain, due to limited evidence and few case reports. Methods: Between March 2023 and April 2025, eight consecutive patients with PIVSD underwent delayed surgical repair following transaxillary pVAD support at our institution. Baseline characteristics, perioperative data, and short-term outcomes were retrospectively analyzed. Results: The median interval from transaxillary pVAD implantation to surgical repair was 8.5 days (IQR: 7.5–13). All patients ( n = 8) subsequently underwent successful surgical patch closure with bovine pericardium (three of them combined with the Dor procedure). All patients remained on pVAD support postoperatively, with a median perioperative support duration of 15 days (IQR: 11.75–19.75). One patient died from refractory right heart failure despite ECMO support following total occlusion of the right coronary artery. The remaining seven patients were successfully weaned from pVAD. The median duration in the intensive care unit was 21 days (IQR: 16.5–30). While three patients required surgical revision for bleeding at the axillary access site, neurological complications were not observed. In-hospital and 30-day mortality were both 12.5% ( n = 1). Conclusion: Perioperative support with transaxillary pVAD may represent a justified bridge-to-closure strategy for patients with PIVSD with promising survival rates. The pVAD-related bleeding at the access site was the most frequent complication. Larger studies are required to further evaluate the safety and efficacy of bridge to closure strategies of transaxillary pVAD in PIVSD. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany