主动脉内球囊反搏支持与梗死后室间隔破裂外科修补术后早期死亡：一项24年真实世界队列
Intra-aortic balloon pump support and early mortality after surgical repair of post-infarction ventricular septal rupture: A 24-year real-world cohort
梗死后室间隔破裂（心梗后心脏隔膜破口）外科修补后早期死亡率仍很高，围手术期是否使用主动脉内球囊反搏（IABP，经股动脉置入的辅助泵血装置）一直存疑。本研究回顾性纳入一家心血管中心24年间连续59例接受外科修补的患者，平均65.3岁，57.6%为男性，30天总死亡率54.4%，64.4%使用了IABP。多变量分析显示术后使用IABP与30天死亡显著降低独立相关（OR 0.014），术前使用呈保护趋势但未达统计学意义。作者认为IABP在特定患者中仍有实用价值，但这是单中心回顾性观察，不能证明因果。
为什么推荐给您：成熟器械的长期单中心回顾性队列，属常规增量证据，非新疗法。
不需要生物学背景，多打比方
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摘要Abstract
BACKGROUND: Post-infarction ventricular septal rupture (VSR) remains a rare but highly lethal complication of acute myocardial infarction, with persistently high early mortality. Although surgical repair is the definitive treatment, the optimal perioperative management strategy remains uncertain, particularly regarding the role of intra-aortic balloon pump (IABP) support.
METHODS: We conducted a retrospective cohort study including consecutive patients with post-infarction VSR who underwent surgical repair at a tertiary cardiovascular centre over a 24-year period. Clinical characteristics, timing of diagnosis and surgery, use and timing of IABP support, and 30-day all-cause mortality were analysed. Multivariable logistic regression was performed to identify independent predictors of early mortality. Patients managed conservatively or treated exclusively with percutaneous closure were not included.
RESULTS: A total of 59 patients were included (mean age 65.3 ± 10.2 years; 57.6% male). Overall 30-day mortality was 54.4%. IABP support was used in 64.4% of patients, including 33.9% pre-operatively and 30.5% post-operatively. Non-survivors experienced longer delays from symptom onset to surgery and from hospital admission to surgery. In multivariable analysis, post-operative IABP use was independently associated with lower 30-day mortality (OR 0.014, 95% CI 0.001-0.120; p = 0.001). Pre-operative IABP use showed a protective trend but did not reach statistical significance (OR 0.161, 95% CI 0.016-1.062; p = 0.077).
CONCLUSIONS: In this real-world cohort characterised by delayed diagnosis and referral, perioperative IABP support was strongly associated with improved early survival after surgical repair of post-infarction VSR, supporting its pragmatic role as haemodynamic support in selected patients.