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Updated: Jun 27, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Hemodynamically supported percutaneous coronary revascularization improves left ventricular function in patients with
Giorgio Gimelli1, Matthew R Wolff
1Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA. gxg@medicine.wisc.edu
Insights
Percutaneous left ventricular assist devices (pLVAD) support complex PCI in high-risk patients with ischemic cardiomyopathy, significantly improving left ventricular ejection fraction (LVEF). This approach offers a feasible and safe alternative to surgery, enhancing cardiac function.
Area of Science:
- Cardiology
- Interventional Cardiology
- Heart Failure Management
Background:
- Coronary artery bypass grafting poses high risks for patients with ischemic cardiomyopathy due to age and comorbidities.
- Percutaneous left ventricular assist devices (pLVAD) offer a potential alternative to surgery for complex percutaneous coronary interventions (PCI) in patients with severely impaired left ventricular function.
- Long-term outcomes of hemodynamically-supported PCI in these high-risk patients remain unclear.
Purpose of the Study:
- To evaluate the impact of hemodynamically-supported multivessel PCI on left ventricular ejection fraction (LVEF).
- To assess the feasibility and safety of pLVAD use in patients with severe ischemic cardiomyopathy and very high operative risk.
Main Methods:
- Retrospective analysis of patients with ischemic cardiomyopathy and high surgical risk undergoing prophylactic pLVAD implantation for PCI.
- Echocardiography was used to assess changes in LVEF at least 90 days post-PCI.
- In-hospital adverse cardiovascular events (MACE), vascular complications, and mortality were secondary endpoints.
Main Results:
- Eleven high-risk patients (mean age 73) with ischemic cardiomyopathy underwent TandemHeart-supported PCI.
- Baseline LVEF improved from 25% to 41% at a mean follow-up of 15 months (p=0.0004).
- No in-hospital MACE and only one vascular complication requiring transfusion were observed.
Conclusions:
- pLVAD-supported PCI is a feasible and relatively safe option for patients with ischemic cardiomyopathy at high surgical risk.
- This approach, combined with medical therapy, leads to significant improvements in LVEF.
- pLVADs may facilitate complex PCI in high-risk patients, potentially avoiding traditional surgery.
Background:
Coronary artery bypass grafting is often considered for patients with ischemic cardiomyopathy, but age, comorbidities and depressed left ventricular function can increase surgical risk. Percutaneous left ventricular assist devices (pLVAD) may facilitate complex percutaneous coronary interventions (PCI) in the setting of severely impaired left ventricular function, thus providing a possible alternative to thoracotomy in high-risk patients. The long-term effects of hemodynamically-supported PCI on left ventricular function and clinical outcome in these patients are poorly understood.
Objective:
To determine the effect of hemodynamically-supported multivessel PCI on left ventricular ejection fraction (LVEF) in patients with severe ischemic cardiomyopathy at very high operative risk.
Methods:
Retrospective case-series analysis of patients with ischemic cardiomyopathy at very high surgical risk who underwent prophylactic pLVAD implantation for hemodynamic support during complex PCI between January 2004 and February 2007. The main outcome variable was change in LVEF assessed by echocardiography 90 days or more after PCI. Major in-hospital adverse cardiovascular events (MACE), vascular complications and all-cause mortality were secondary endpoints.
Results:
Eleven patients with prior myocardial infarction and ischemic cardiomyopathy (mean age 73 +/- 14 years) underwent TandemHeart-supported PCI. The indications for prophylactic support were depressed LVEF and a large myocardial mass at risk. Baseline LVEF was 25 +/- 8%, increasing to 41 +/- 9% at a mean follow-up time of 15 +/- 15 months (p = 0.0004). There were no in-hospital MACE and only 1 vascular complication requiring blood transfusion.
Conclusions:
PLVAD-supported PCI in patients with ischemic cardiomyopathy at very high risk for surgery is feasible and relatively safe. In combination with medical therapy, it results in significant improvement in LVEF by echocardiography.
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