{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T14:47:16Z","timestamp":1775227636916,"version":"3.50.1"},"reference-count":5,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,5,17]],"date-time":"2021-05-17T00:00:00Z","timestamp":1621209600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,5,17]],"date-time":"2021-05-17T00:00:00Z","timestamp":1621209600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100002130","name":"Heineman Foundation","doi-asserted-by":"publisher","award":["88-2019"],"award-info":[{"award-number":["88-2019"]}],"id":[{"id":"10.13039\/100002130","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Cardiothorac Surg"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Despite advances in surgical techniques and aggressive therapy of post-infarction ventricular septal defect (VSD) with cardiogenic shock, the overall morbidity and mortality is frustratingly high. The Impella 5.5 SmartAssist (Abiomed, Danvers, MA) is a surgically implanted temporary device, recently approved by the FDA (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.businesswire.com\/news\/home\/20190925005454\/en\/\">https:\/\/www.businesswire.com\/news\/home\/20190925005454\/en\/<\/jats:ext-link>) for treatment of patients in cardiogenic shock, and may fill a technological gap for patients who require acute circulatory support after VSD closure.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>We report our initial experience for two patients with post myocardial infarction VSD in the setting of cardiogenic shock supported with trans-aortic implantation Impella 5.5 SmartAssist. First patient had a posterior VSD with a left to right shunt (Qp\/Qs ratio of 3.3), blood pressure 80\/35\u2009mmHg, right ventricle dysfunction, severe pulmonary arterial hypertension (an estimated systolic pulmonary artery pressure of 45\u2009mmHg), and severe mitral valve regurgitation. Second patient was admitted for massive MI with large anterior VSD (Qp\/Qs ratio of 2.8). Under cardiopulmonary bypass with cardioplegic arrest both patients underwent urgent VSD closure with trans-aortic implantation of the Impella. Minimal postoperative support was required. Patients were discharged on postoperative day 10 and 14 and remained well 3 months later. Follow-up echocardiogram showed no residual shunt.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Early surgical implantation of Impella 5.5 SmartAssist can prevent multiorgan dysfunction and stabilize the patients in cardiogenic shock with post-myocardial infarction VSD.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13019-021-01513-y","type":"journal-article","created":{"date-parts":[[2021,5,17]],"date-time":"2021-05-17T13:02:54Z","timestamp":1621256574000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Advantages of intraoperative implantation of Impella 5.5 SmartAssist in the Management of Acute Post-Infarction Ventricular Septal Defect with cardiogenic shock"],"prefix":"10.1186","volume":"16","author":[{"given":"Jeko M.","family":"Madjarov","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4614-1485","authenticated-orcid":false,"given":"Michael G.","family":"Katz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Svetozar","family":"Madzharov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shahood","family":"Fazal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis","family":"Robicsek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,5,17]]},"reference":[{"issue":"17","key":"1513_CR1","doi-asserted-by":"publisher","first-page":"2117","DOI":"10.1016\/j.jacc.2019.07.077","volume":"74","author":"JC Jentzer","year":"2019","unstructured":"Jentzer JC, van Diepen S, Barsness GW, Henry TD, Menon V, Rihal CS, et al. Cardiogenic shock classification to predict mortality in the cardiac intensive care unit. J Am Coll Cardiol. 2019;74(17):2117\u201328. https:\/\/doi.org\/10.1016\/j.jacc.2019.07.077.","journal-title":"J Am Coll Cardiol"},{"issue":"2","key":"1513_CR2","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1016\/S1010-7940(00)00482-6","volume":"18","author":"MA Deja","year":"2000","unstructured":"Deja MA, Szostek J, Widenka K, Szafron B, Spyt TJ, Hickey MS, et al. Post infarction ventricular septal defect - can we do better? Eur J Cardiothorac Surg. 2000;18(2):194\u2013201. https:\/\/doi.org\/10.1016\/S1010-7940(00)00482-6.","journal-title":"Eur J Cardiothorac Surg"},{"issue":"4","key":"1513_CR3","doi-asserted-by":"publisher","first-page":"e362","DOI":"10.1161\/CIR.0b013e3182742cf6","volume":"127","author":"PT O'Gara","year":"2013","unstructured":"O'Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, et al. 2013 ACCF\/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation\/American Heart Association task force on practice guidelines. Circulation. 2013;127(4):e362\u2013425. https:\/\/doi.org\/10.1161\/CIR.0b013e3182742cf6.","journal-title":"Circulation"},{"issue":"1","key":"1513_CR4","first-page":"46","volume":"35","author":"ID Gregoric","year":"2008","unstructured":"Gregoric ID, Bieniarz MC, Arora H, Frazier OH, Kar B, Loyalka P. Percutaneous ventricular assist device support in a patient with a postinfarction ventricular septal defect. Tex Heart Inst J. 2008;35(1):46\u20139.","journal-title":"Tex Heart Inst J"},{"issue":"3","key":"1513_CR5","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1016\/j.athoracsur.2016.12.049","volume":"104","author":"S Tepper","year":"2017","unstructured":"Tepper S, Masood MF, Patel K, Garcia MB, Pisani M, Ewald GA, et al. Left ventricular unloading by Impella device versus durgical vent during exytacorporeal life support. Ann Thorac Surg. 2017;104(3):861\u20137. https:\/\/doi.org\/10.1016\/j.athoracsur.2016.12.049.","journal-title":"Ann Thorac Surg"}],"container-title":["Journal of Cardiothoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-021-01513-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13019-021-01513-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-021-01513-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,17]],"date-time":"2021-05-17T13:07:08Z","timestamp":1621256828000},"score":1,"resource":{"primary":{"URL":"https:\/\/cardiothoracicsurgery.biomedcentral.com\/articles\/10.1186\/s13019-021-01513-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,17]]},"references-count":5,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1513"],"URL":"https:\/\/doi.org\/10.1186\/s13019-021-01513-y","relation":{},"ISSN":["1749-8090"],"issn-type":[{"value":"1749-8090","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,17]]},"assertion":[{"value":"3 August 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 May 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 May 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The patients signed informed consent.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"None declared","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"132"}}