Intra-aortic balloon pump support and early mortality after surgical repair of post-infarction ventricular septal rupture: A 24-year real-world cohort

Abstract

Background Post-infarction ventricular septal rupture (VSR) remains a rare but highly lethal complication of acute myocardial infarction, with persistently high early mortality. Although surgical repair is the definitive treatment, the optimal perioperative management strategy remains uncertain, particularly regarding the role of intra-aortic balloon pump (IABP) support. Methods We conducted a retrospective cohort study including consecutive patients with post-infarction VSR who underwent surgical repair at a tertiary cardiovascular centre over a 24-year period. Clinical characteristics, timing of diagnosis and surgery, use and timing of IABP support, and 30-day all-cause mortality were analysed. Multivariable logistic regression was performed to identify independent predictors of early mortality. Patients managed conservatively or treated exclusively with percutaneous closure were not included. Results A total of 59 patients were included (mean age 65.3 ± 10.2 years; 57.6% male). Overall 30-day mortality was 54.4%. IABP support was used in 64.4% of patients, including 33.9% pre-operatively and 30.5% post-operatively. Non-survivors experienced longer delays from symptom onset to surgery and from hospital admission to surgery. In multivariable analysis, post-operative IABP use was independently associated with lower 30-day mortality (OR 0.014, 95% CI 0.001–0.120; p = 0.001). Pre-operative IABP use showed a protective trend but did not reach statistical significance (OR 0.161, 95% CI 0.016–1.062; p = 0.077). Conclusions In this real-world cohort characterised by delayed diagnosis and referral, perioperative IABP support was strongly associated with improved early survival after surgical repair of post-infarction VSR, supporting its pragmatic role as haemodynamic support in selected patients.