[Heart transplantation in acute myocardial infarction]

Ten patients with cardiogenic shock after acute myocardial infarction were referred to the University Hospital Henri Mondor as candidates for cardiac transplantation. The period before transplantation was bridged by maximal pharmacological support including sympathomimetic and phosphodiesterase inhibitor inotropic agents and, in non-responders, by mechanical ventricular assist devices (1 case) or artificial hearts (2 cases). The 7 patients who improved with optimal pharmacological support alone had a good initial course. However, only two of these patients were finally transplanted, three died suddenly either in the intensive care unit or after withdrawal of intravenous drugs and hospital discharge. One patient remained well and after coronary bypass surgery, enjoys good quality life. One patient was found secondarily to be a poor candidate for transplantation and died shortly after. The outcome of 2 of the 3 patients who did not respond to pharmacological treatment and who required mechanical support was spectacularly good and enabled successful cardiac transplantation. Our experience underlines the numerous difficulties of different natures of cardiac transplantation in this indication, the value and risks of the new inotropic agents, and the real but limited role of heroic procedures such as the artificial heart.