Delayed Surgical Closure of Post-Infarct Ventricular Septal Defect With Transaxillary Microaxial Flow Pump Bridging

Background: Ventricular septal defects are catastrophic complications of acute myocardial infarction associated with poor prognosis and high in-hospital mortality. Transaxillary microaxial flow pump (tMAFP) support may provide hemodynamic stabilization and serve as an effective bridge to delayed surgical repair with improved survival outcomes. We aimed to describe perioperative management and outcomes of surgical post-infarct ventricular septal defects (PIVSD) repair with and without tMAFP bridging, hypothesizing that tMAFP support would facilitate delayed repair with favorable operative and survival outcomes. Methods: We retrospectively reviewed 34 patients diagnosed with PIVSD at a single tertiary center between January 2018 and May 2025, stratified by the use of tMAFP. This report focuses on the surgical repair subgroup, describing perioperative management and outcomes with or without tMAFP bridging. Results: Of 20 surgical patients, nine were bridged with tMAFP. These patients had a longer stabilization period before repair (median 14 vs. 3 days), shorter cardiopulmonary bypass times, higher preoperative mobility, and no in-hospital mortality, compared with five deaths among 11 patients repaired without tMAFP bridging. None in the tMAFP group required postoperative VA-ECMO, and no device-related complications were observed. Conclusions: In this retrospective cohort study, tMAFP support allowed delayed surgical repair in PIVSD with favorable perioperative outcomes and survival.