Postinfarct ventricular septal defect (PIVSD) is a rare but highly morbid complication after myocardial infarction (MI). Recent advances in extracorporeal life support (ECLS) therapies provide an option for hemodynamic stabilization and potential for delaying definitive surgical repair, which has historically been associated with improved outcomes.

The Society of Thoracic Surgeons Adult Cardiac Surgery Database was queried to identify patients who underwent operative repair of a PIVSD from 2014 to 2022. Outcomes were compared between those who received preoperative ECLS vs no preoperative ECLS and between those who received preoperative ECLS vs intraoperative/postoperative ECLS. Risk-adjusted analysis of the effect of preoperative ECLS on 30-day mortality was performed using logistic regression. Multivariable logistic regression was used to evaluate the predictors of ECLS timing.

Among the cohort 2024 patients, preoperative ECLS was used in 392 patients (19%), intraoperative ECLS in 156 (8%), postoperative ECLS in 73 (4%), and no ECLS in 1403 (69%). Preoperative ECLS was associated with a higher adjusted 30-day mortality compared with those who did not receive preoperative ECLS (odds ratio, 1.37; 95% CI, 1.03-183; P = .032), but a significantly lower adjusted 30-day mortality compared only with patients who received intraoperative/postoperative ECLS (odds ratio, 0.39; 95% CI, 0.26-0.60; P < .001).

The observation that operative mortality continues to decrease over time as preoperative ECLS use increases merits continued investigation. Preoperative ECLS, compared with intraoperative/postoperative implementation, may be associated with improved postoperative outcomes. Future investigation will focus on which patients benefit most from immediate repair vs delayed repair with preoperative ECLS.