PURPOSE: Post myocardial infarction ventricular septal defect (PMI-VSD) complicated by refractory cardiogenic shock is associated with an extremely high mortality rate. We sought to evaluate the factors associated with in-ICU mortality in patients with PMI-VSD-related cardiogenic shock. METHODS: Patients with PMI-VSD complicated by cardiogenic shock, admitted in 10 French tertiary centers between 2008 and 2022, were retrospectively included. The primary outcome was in-ICU mortality. The timing of surgery was classified as early (≤ 7 days) or late (>
7 days). Multivariable analysis was performed to identify the variables associated with in-ICU mortality. RESULTS: A total of 138 patients were included (mean age 70 (± 10) years, female sex 54%). Of these, 116 patients (84%) received MCS, including 43 patients (31%) with VA-ECMO. VSD surgical closure was performed in 93 patients (67%, 60 early, 33 late). Only 2 patients had percutaneous closure without surgical repair. A total of 84 patients (61%) died. The type of surgical management strategy was significantly associated with in-ICU mortality (no surgery, 100%
early surgery, 45%
late surgery, 27%
p CONCLUSION: Delayed VSD closure is associated with improved outcomes in PMI-VSD complicated by cardiogenic shock. TRIAL REGISTRATION: #CE SRLF 19-34, #CNIL MR004 2224973, retrospectively registered 04 July 2019.