4.3 Factors affecting TCC outcomes for PIVSD
Cardiogenic shock(CS) is a terrible complication of PIVSD accompanied by the high mortality rate is approximately 89%[2]. Our data suggest that patients who developed VSD and died were the more likely to the occurrence of CS before TCC. Accompanied by catastrophic mortality (about 87%) and reduced progression on patients with CS also in the SHOCK trial[1]. Similarly, majorities studies have confirmed the same conclusion[10,15,18,32]. In high surgical-risk patients with PIVSD, NYHA class IV and a long time from VSD to transcatheter are also correlated with high mortality,while the defect size and have no relevance to the mortality. There may be a variety of mechanisms for these results.
On the one hand, When NYHA class IV indicates the patients with a terrible clinical state, they need the support of inotropes or IABP, even the surgical repair promptly. Now keeping the stability of the hemodynamics is a critical therapeutic strategy at an early stage of PIVSD. On the other hand, and it is hard to find available occlude devices and lack of firm tissue to seat the device for large defect sizes. Unpaired occluder will generate resident shunt and long-term residual shunt can lead to infective endocarditis and even left ventricular rupture [33,34]. Moreover, in their studies, Shi Tai et al. Calvert et al. found that advanced age and female sex are risk factors for PIVSD patients. The following explanation about why women with increased risk of VSD is given by Andrew: “Contributing factors may include women’s older age at presentation, greater comorbidities, frequency of atypical symptoms leading to treatment delay, and decreased likelihood of treatment with guideline-driven medical and reperfusion therapies[35,36] ”.