{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T13:51:03Z","timestamp":1785851463584,"version":"3.56.0"},"reference-count":13,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ventricular septal perforation (VSP) is a catastrophic complication of acute myocardial infarction frequently associated with cardiogenic shock. Combined venoarterial extracorporeal membrane oxygenation (VA\u2010ECMO) and Impella support (ECPELLA) has emerged as a promising strategy for circulatory stabilization; however, the hemodynamic effects of varying support configurations remain poorly understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate the balance between systemic circulatory support and ventricular unloading across a spectrum of ECPELLA configurations using a computational cardiovascular model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A lumped\u2010parameter cardiovascular model incorporating left and right ventricles, systemic and pulmonary circulations, post\u2010infarction VSP, VA\u2010ECMO, and Impella support was developed. Five ECPELLA configurations ranging from ECMO\u2010dominant to Impella\u2010dominant support were simulated. Left ventricular (LV) pressure\u2013volume loops, LV stroke work (LVSW), systemic flow, mean arterial pressure, and shunt\u2010related hemodynamics were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Increasing Impella contribution progressively shifted LV pressure\u2013volume loops leftward and reduced loop area, indicating enhanced ventricular unloading. LVSW decreased from 7082 to 6137\u2009mmHg\u00b7mL, representing an approximately 13% reduction between ECMO\u2010dominant and Impella\u2010dominant configurations. Mean systemic perfusion increased by approximately 6% (87.6 to 93.0\u2009mL\/s) across the support spectrum. No discrete hemodynamic optimum was identified; instead, systemic flow increased while ventricular workload decreased progressively with increasing Impella contribution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this computational model of post\u2010infarction VSP, progressively greater Impella contribution was associated with improved systemic perfusion and reduced ventricular mechanical workload. These findings suggest that optimization of the balance between circulatory support and ventricular unloading may represent a fundamental principle of ECPELLA management in VSP.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.70793","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T13:20:26Z","timestamp":1785849626000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Balancing Circulatory Support and Ventricular Unloading in Post\u2010Infarction Ventricular Septal Perforation: A Computational Analysis of ECPELLA Support Configurations"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7642-0346","authenticated-orcid":false,"given":"Yuhi","family":"Nakamura","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery Shizuoka Medical Center Shizuoka Japan"},{"name":"Department of Cardiovascular Surgery Kitasato University School of Medicine Sagamihara Japan"},{"name":"Cardiovascular Surgery National Center for Global Health and Medicine Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5594-8072","authenticated-orcid":false,"given":"Hisato","family":"Takagi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery Shizuoka Medical Center Shizuoka Japan"},{"name":"Department of Cardiovascular Surgery Kitasato University School of Medicine Sagamihara Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"issue":"31","key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"2060","DOI":"10.1093\/eurheartj\/ehu248","article-title":"Ventricular Septal Rupture Complicating Acute Myocardial Infarction: A Contemporary Review","volume":"35","author":"Jones B. M.","year":"2014","journal-title":"European Heart Journal"},{"issue":"2","key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.athoracsur.2012.04.020","article-title":"Surgical Repair of Ventricular Septal Defect After Myocardial Infarction: Outcomes From the Society of Thoracic Surgeons National Database","volume":"94","author":"Arnaoutakis G. J.","year":"2012","journal-title":"Annals of Thoracic Surgery"},{"issue":"7","key":"e_1_2_8_4_1","article-title":"Hemodynamic Effects of Mechanical Circulatory Support Devices in Ventricular Septal Defect","volume":"12","author":"Pahuja M.","year":"2019","journal-title":"Circulation: Heart Failure"},{"issue":"12","key":"e_1_2_8_5_1","first-page":"1035","article-title":"Unloading of the Left Ventricle During Venoarterial Extracorporeal Membrane Oxygenation Therapy in Cardiogenic Shock","volume":"6","author":"Schrage B.","year":"2018","journal-title":"JACC: Heart Failure"},{"issue":"3","key":"e_1_2_8_6_1","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1002\/ejhf.668","article-title":"Concomitant Implantation of Impella on Top of Veno\u2010Arterial Extracorporeal Membrane Oxygenation May Improve Survival of Patients With Cardiogenic Shock","volume":"19","author":"Pappalardo F.","year":"2017","journal-title":"European Journal of Heart Failure"},{"issue":"1","key":"e_1_2_8_7_1","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1097\/MAT.0000000000000767","article-title":"Simultaneous Venoarterial Extracorporeal Membrane Oxygenation and Percutaneous Left Ventricular Decompression Therapy With Impella Is Associated With Improved Outcomes in Refractory Cardiogenic Shock","volume":"65","author":"Patel S. M.","year":"2019","journal-title":"ASAIO Journal"},{"issue":"22","key":"e_1_2_8_8_1","doi-asserted-by":"crossref","first-page":"2095","DOI":"10.1161\/CIRCULATIONAHA.120.048792","article-title":"Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation: Results From an International, Multicenter Cohort Study","volume":"142","author":"Schrage B.","year":"2020","journal-title":"Circulation"},{"issue":"2","key":"e_1_2_8_9_1","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.jjcc.2022.02.013","article-title":"Benefit of Veno\u2010Arterial Extracorporeal Membrane Oxygenation Combined With Impella (ECpella) Therapy in Acute Coronary Syndrome With Cardiogenic Shock","volume":"80","author":"Shibasaki I.","year":"2022","journal-title":"Journal of Cardiology"},{"issue":"1","key":"e_1_2_8_10_1","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1161\/01.RES.35.1.117","article-title":"Instantaneous Pressure\u2010Volume Relationships and Their Ratio in the Excised, Supported Canine Left Ventricle","volume":"35","author":"Suga H.","year":"1974","journal-title":"Circulation Research"},{"issue":"23","key":"e_1_2_8_11_1","first-page":"2663","article-title":"Hemodynamics of Mechanical Circulatory Support","volume":"66","author":"Burkhoff D.","year":"2015","journal-title":"Journal of the American College of Cardiology"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11538-015-0088-2"},{"issue":"6","key":"e_1_2_8_13_1","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1111\/jocs.14560","article-title":"Impella to Unload the Left Ventricle in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock: A Systematic Review and Meta\u2010Analysis","volume":"35","author":"Grajeda Silvestri E. R.","year":"2020","journal-title":"Journal of Cardiac Surgery"},{"issue":"15","key":"e_1_2_8_14_1","doi-asserted-by":"crossref","first-page":"e1585","DOI":"10.4244\/EIJ-D-18-00684","article-title":"Impella CP or VA\u2010ECMO in Profound Cardiogenic Shock: Left Ventricular Unloading and Organ Perfusion in a Large Animal Model","volume":"14","author":"M\u00f8ller\u2010Helgestad O. 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