DOI: https://doi.org/10.14710/jai.v0i0.82962

From Cardiac Arrest to Definitive Repair: Delayed VSR Closure and CABG in Post-Infarction Ventricular Septal Rupture

1Fellowship of Adult Cardiac Anesthesia, Department of Anesthesiology and Intensive Therapy, dr. Kariadi Hospital, Semarang, Indonesia, Indonesia

2Department of Anesthesiology and Intensive Therapy, dr. Kariadi Hospital, Semarang, Indonesia, Indonesia

3Department of General Medicine, Bhakti Wira Tamtama Hospital, Semarang, Indonesia, Indonesia

Received: 7 Mar 2026; Revised: 29 Oct 2026; Accepted: 2 Nov 2026; Available online: 2 Nov 2026.
Open Access Copyright 2026 JAI (Jurnal Anestesiologi Indonesia)
Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License.

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Abstract

Background: Post-myocardial infarction ventricular septal rupture (VSR) complicated by cardiac arrest and cardiogenic shock stage E by SCAI[A1]  (Society for Cardiovascular Angiography and Interventions stage) is a catastrophic event with prohibitive surgical mortality. While immediate repair is fraught with risks due to tissue friability, optimal timing remains debated. We highlight a "stabilize-then-delay" strategy that utilizes the Intra-Aortic Balloon Pump (IABP) as a crucial hemodynamic bridge to facilitate delayed definitive repair.

Case: We report a case of a patient presenting with post-MI VSR and single-vessel disease who suffered cardiogenic shock (SCAI stage E) complicated by cardiac arrest on January 22, 2026. Following resuscitation, IABP support was immediately initiated as a bridge to surgery, allowing for significant hemodynamic stabilization and successful extubation on January 27, 2026. This stability permitted a strategic 12-day delay from the arrest event to surgery. Definitive repair, consisting of VSR closure and coronary artery bypass grafting (CABG), was performed on February 3, 2026. The patient achieved early postoperative extubation and successful IABP weaning. However, a residual shunt was noted on postoperative day two, highlighting the complexity of tissue management even with delayed intervention.

Discussion: This case demonstrates that an IABP-mediated "stabilize-then-delay" strategy was feasible even in extreme conditions such as stage E SCAI shock. In the shift from emergency surgery to stable, semi-elective surgery, IABP serves as a crucial bridge, enabling organ recovery before repair.

Conclusion: In selected patients who stabilize after profound shock, temporary mechanical circulatory support may provide time for end-organ recovery before surgical VSR repair. The risks of deterioration during the waiting period and postoperative residual shunting require continued individualized assessment.

 [A1]You should write the full name of SCAI before writing the abbreviation.

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Keywords: bridge to surgery; cardiac arrest; intra-aortic balloon pump; myocardial infarction; ventricular septal rupture.

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Section: Case Reports
Language : EN
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