Intra-aortic balloon pump use strongly improves survival after post-infarction ventricular septal rupture: insights from a brazilian cohort

Abstract Background Ventricular septal defect (VSD) following acute myocardial infarction (AMI) is a rare but devastating mechanical complication associated with high mortality, even after surgical repair. The intra-aortic balloon pump (IABP) aims to enhance cardiac output and coronary perfusion and is frequently used in pre- and/or postoperative settings; however, the optimal timing of its use remains uncertain. Purpose To evaluate the impact of pre- and postoperative IABP use on in-hospital mortality in patients undergoing surgical repair of post-infarction VSD. Methods This retrospective single-centre cohort study was conducted at a tertiary cardiology hospital in Brazil and included 59 patients with post-AMI VSD who underwent surgical repair between 2000 and 2024. Statistical analyses were performed using R version 4.2.2. The chi-squared or Mann–Whitney test was applied for bivariate comparisons, and binary logistic regression with stepwise selection was used to identify independent predictors of in-hospital death. Variables entered into the final model were age, preoperative IABP, and postoperative IABP. A two-sided significance level of 5% (p 0.05) was adopted. Results IABP was used in 64.4% of patients (33.9% preoperatively and 30.5% postoperatively). Overall in-hospital mortality was 52.5% (31/59). IABP use overall was significantly associated with in-hospital survival (p 0.001). Postoperative IABP use was markedly more frequent among survivors (57.7% vs. 6.5%, p0.001).In multivariable logistic regression, only postoperative IABP use remained an independent protective factor (OR = 0.014; 95% CI 0.001–0.120; p = 0.001). Preoperative IABP showed a non-significant protective trend (OR = 0.161; 95% CI 0.016–1.062; p = 0.077). Conclusions Hospital mortality after surgical repair of post-AMI VSD remains extremely high. IABP use overall was strongly associated with improved in-hospital survival; however, only postoperative IABP maintained independent significance after adjustment. These findings suggest that the survival benefit associated with IABP is primarily driven by its postoperative use, likely through improved hemodynamic support and myocardial perfusion during the critical early recovery phase.