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Title:           The current clinical practice for management of post-infarction ventricular septal rupture: a European survey
Subject:         DOI: 10.1093/ehjopen/oead091; European Heart Journal Open, 3, 5, 2023-9-22.; Abstract:  Aims: Many historical and recent reports showed that post-infarction ventricular septal rupture (VSR) represents a life-threatening condition and the strategy to optimally manage it remains undefined. Therefore, disparate treatment policies among different centres with variable results are often described. We analysed data from European centres to capture the current clinical practice in VSR management. Methods and results: Thirty-nine centres belonging to eight European countries participated in a survey, filling a digital form of 38 questions from April to October 2022, to collect information about all the aspects of VSR treatment. Most centres encounter 1–5 VSR cases/year. Surgery remains the treatment of choice over percutaneous closure (71.8% vs. 28.2%). A delayed repair represents the preferred approach (87.2%). Haemodynamic conditions influence the management in almost all centres, although some try to achieve patients stabilization and delayed surgery even in cardiogenic shock. Although 33.3% of centres do not perform coronarography in unstable patients, revascularization approaches are widely variable. Most centres adopt mechanical circulatory support (MCS), mostly extracorporeal membrane oxygenation, especially pre-operatively to stabilize patients and achieve delayed repair. Post-operatively, such MCS are more often adopted in patients with ventricular dysfunction. Conclusion: In real-life, delayed surgery, regardless of the haemodynamic conditions, is the preferred strategy for VSR management in Europe. Extracorporeal membrane oxygenation is becoming the most frequently adopted MCS as bridge-to-operation. This survey provides a useful background to develop dedicated, prospective studies to strengthen the current evidence on VSR treatment and to help improving its currently unsatisfactory outcomes.
Keywords:        Ventricular septal rupture; Acute myocardial infarction; Mechanical complication; Mechanical circulatory support; Extracorporeal membrane oxygenation; Cardiogenic shock
Author:          Daniele Ronco
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               <rdf:li>Daniele Ronco</rdf:li>
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               <rdf:li>Michele De Bonis</rdf:li>
               <rdf:li>Claudio Francesco Russo</rdf:li>
               <rdf:li>Aitor Uribarri</rdf:li>
               <rdf:li>Santiago Montero</rdf:li>
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               <rdf:li>Shiho Naito</rdf:li>
               <rdf:li>Jean-François Obadia</rdf:li>
               <rdf:li>Roberto Martín-Asenjo</rdf:li>
               <rdf:li>Jaime Aboal</rdf:li>
               <rdf:li>Matthias Thielmann</rdf:li>
               <rdf:li>Caterina Simon</rdf:li>
               <rdf:li>Rut Andrea-Riba</rdf:li>
               <rdf:li>Carolina Parra</rdf:li>
               <rdf:li>Thierry Folliguet</rdf:li>
               <rdf:li>Manuel Martínez-Sellés</rdf:li>
               <rdf:li>Marcelo Sanmartín Fernández</rdf:li>
               <rdf:li>Nawwar Al-Attar</rdf:li>
               <rdf:li>Ana Viana Tejedor</rdf:li>
               <rdf:li>Giuseppe Filiberto Serraino</rdf:li>
               <rdf:li>Virginia Burgos Palacios</rdf:li>
               <rdf:li>Udo Boeken</rdf:li>
               <rdf:li>Sergio Raposeiras Roubin</rdf:li>
               <rdf:li>Miguel Antonio Solla Buceta</rdf:li>
               <rdf:li>Pedro Luis Sánchez Fernández</rdf:li>
               <rdf:li>Roberto Scrofani</rdf:li>
               <rdf:li>Gemma Pastor Báez</rdf:li>
               <rdf:li>Pablo Jorge Pérez</rdf:li>
               <rdf:li>Guglielmo Actis Dato</rdf:li>
               <rdf:li>Juan Carlos Garcia-Rubira</rdf:li>
               <rdf:li>Jose H. de Gea Garcia</rdf:li>
               <rdf:li>Giulio Massimi</rdf:li>
               <rdf:li>Andrea Musazzi</rdf:li>
               <rdf:li>Roberto Lorusso</rdf:li>
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               <rdf:li xml:lang="x-default">DOI: 10.1093/ehjopen/oead091; European Heart Journal Open, 3, 5, 2023-9-22.; Abstract:  Aims: Many historical and recent reports showed that post-infarction ventricular septal rupture (VSR) represents a life-threatening condition and the strategy to optimally manage it remains undefined. Therefore, disparate treatment policies among different centres with variable results are often described. We analysed data from European centres to capture the current clinical practice in VSR management. Methods and results: Thirty-nine centres belonging to eight European countries participated in a survey, filling a digital form of 38 questions from April to October 2022, to collect information about all the aspects of VSR treatment. Most centres encounter 1–5 VSR cases/year. Surgery remains the treatment of choice over percutaneous closure (71.8% vs. 28.2%). A delayed repair represents the preferred approach (87.2%). Haemodynamic conditions influence the management in almost all centres, although some try to achieve patients stabilization and delayed surgery even in cardiogenic shock. Although 33.3% of centres do not perform coronarography in unstable patients, revascularization approaches are widely variable. Most centres adopt mechanical circulatory support (MCS), mostly extracorporeal membrane oxygenation, especially pre-operatively to stabilize patients and achieve delayed repair. Post-operatively, such MCS are more often adopted in patients with ventricular dysfunction. Conclusion: In real-life, delayed surgery, regardless of the haemodynamic conditions, is the preferred strategy for VSR management in Europe. Extracorporeal membrane oxygenation is becoming the most frequently adopted MCS as bridge-to-operation. This survey provides a useful background to develop dedicated, prospective studies to strengthen the current evidence on VSR treatment and to help improving its currently unsatisfactory outcomes.</rdf:li>
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         <dc:rights>
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               <rdf:li xml:lang="x-default">© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.</rdf:li>
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               <rdf:li>Ventricular septal rupture</rdf:li>
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               <rdf:li>Mechanical circulatory support</rdf:li>
               <rdf:li>Extracorporeal membrane oxygenation</rdf:li>
               <rdf:li>Cardiogenic shock</rdf:li>
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         <prism:publicationName>European Heart Journal Open</prism:publicationName>
         <prism:copyright>© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.</prism:copyright>
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         <prism:elssn>2752-4191</prism:elssn>
         <prism:volume>3</prism:volume>
         <prism:number>5</prism:number>
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         <prism:startingPage>1</prism:startingPage>
         <prism:endingPage>7</prism:endingPage>
         <prism:doi>10.1093/ehjopen/oead091</prism:doi>
         <prism:url>https://doi.org/10.1093/ehjopen/oead091</prism:url>
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