The role of impella in the pre-procedural management of post-infarct ventricular septal defect: a systematic review.

Objectives: Post-infarct ventricular septal defect is a rare but devastating complication. Delayed treatment offers better outcomes than emergency surgery, but, when acute cardiogenic shock or unstable haemodynamics occur, temporary mechanical circulatory support may be needed to stabilize patients until treatment. The aim of our systematic review was to assess the outcomes of using Impella in this setting.

Methods: A systematic search was performed in Medline and EMBASE databases and all the papers about the use of Impella in this setting were assessed. The study followed the PRISMA criteria.

Results: A total of 20 papers encompassing 68 patients with an Impella implanted after the diagnosis of post-infarct ventricular septal defect and before its treatment were included. More than 95% were in cardiogenic shock when Impella was implanted, and half had another mechanical circulatory support device. Most of the patients (62%) had a posterior defect and 72% underwent surgical or percutaneous repair. Total in-hospital mortality was 47% and a total of 29 Impella-related complications were observed. Patients with surgical Impella had a numerically lower in-hospital mortality (35% vs 58%) and a lower rate of complications compared to percutaneous device.

Conclusions: Impella represents an effective device for diminishing low output syndrome, improving peripheral perfusion, and unloading both the ventricles. It can be used as an upgrade from another mechanical circulatory support or as an addition to extracorporeal membrane oxygenation to provide adequate left ventricular or biventricular support. Despite this, Impella-related complications can occur after its implantation and must be considered.