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The following is a summary of “ICU mortality of post-myocardial infarction ventricular septal defect complicated by cardiogenic shock: a retrospective multicentric cohort,” published in the March 2025 issue of BMC Critical Care by Azoulay et al. 

Researchers conducted a retrospective study to identify factors linked to in- Intensive care unit (ICU) mortality among individuals with post-myocardial infarction ventricular septal defect (PMI-VSD) related cardiogenic shock.  

They analyzed individuals with PMI-VSD, and cardiogenic shock admitted to 10 tertiary centers between 2008 and 2022. The primary outcome was in-ICU mortality. Surgical timing was categorized as early (≤ 7 days) or late (> 7 days). A multivariable analysis identified factors linked to in-ICU mortality.  

The results showed that 138 individuals were included (mean age 70 (± 10) years, female sex 54%). Mechanical circulatory support (MCS) was used in 116 (84%), including venoarterial extracorporeal membrane oxygenation (VA-ECMO) in 43 (31%). The VSD surgical closure was performed in 93 (67%), with 60 undergoing early surgery and 33 late surgeries. Only 2 had percutaneous closure without surgery. A total of 84 (61%) did not survive. Surgical management strategy significantly influenced in-ICU mortality (no surgery, 100%; early surgery, 45%; late surgery, 27%; P_trend < 0.001). Independent predictors of in-ICU mortality included older age ( Adjusted odds-ratio (aOR) = 1.1, 95%CI [1.02–1.12], P = 0.004), Sequential Organ Failure Assessment (SOFA) score (aOR = 1.2, 95%CI [1.07–1.37], P = 0.003), and VA-ECMO (aOR = 2.9, 95%CI [1.2–7.7], P = 0.02). Among those undergoing VSD surgical closure, a longer delay between ICU admission and surgery was linked to lower in-ICU mortality (aOR = 0.9, 95%CI [0.79–0.96], P = 0.003).  

Investigators concluded that postponing VSD closure after PMI-VSD complicated by cardiogenic shock resulted in better patient outcomes. 

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-025-05321-x