Veno-arterial ECMO as a bridge to delayed repair in post-infarction ventricular septal rupture with cardiogenic shock: a two-center case series

Post-infarction ventricular septal rupture (PIVSR) complicated by cardiogenic shock carries an extremely high mortality rate. While surgical or interventional repair is the definitive treatment, optimal timing remains challenging due to hemodynamic instability. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may stabilize patients and serve as a bridge to delayed repair, but its role requires further investigation. This retrospective case series analyzed all PIVSR patients with cardiogenic shock who received VA-ECMO at two Chinese cardiovascular centers between February 2022 and December 2024. During the study period, 28 PIVSR patients were admitted, including 19 (67.9%) with cardiogenic shock. Seven patients received VA-ECMO (median SAVE score:-6). Following ECMO support, 6 patients (85.7%) achieved hemodynamic stability and underwent delayed surgical repair (median delay from infarction to surgery: 25 days; range 7-48 days). In-hospital survival was 100%, and 90-day survival was 83.3%. Common complications included gastrointestinal bleeding (4/6, 66.7%) and pulmonary infection (5/6, 83.3%), which were managed effectively. In carefully selected PIVSR patients with cardiogenic shock, early VA-ECMO support provides effective circulatory stabilization and serves as a successful bridge to delayed surgical repair, enabling favorable survival outcomes.