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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Published on: June 12, 2021

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Permanent Continuous Flow Left Ventricular Assist Devices Use After Acute Stabilization for Cardiogenic Shock in

Josephine Chou1, Christian Bermudez, Robert Kormos

  • 1From the *Heart and Vascular Institute, Baystate Medical Center, Springfield, Massachusetts; †Department of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; and ‡Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|June 4, 2016
PubMed

Insights

Continuous flow left ventricular assist devices (CF-LVAD) show promise for cardiogenic shock after acute myocardial infarction (CS-AMI). While high-risk, CF-LVADs offer survival benefits for select CS-AMI patients stabilized with temporary support.

Area of Science:

  • Cardiology
  • Mechanical Circulatory Support
  • Cardiovascular Surgery

Background:

  • Cardiogenic shock complicating acute myocardial infarctions (CS-AMIs) has a high mortality rate.
  • Early implantation of durable continuous flow left ventricular assist devices (CF-LVADs) in CS-AMI patients is often discouraged.
  • Temporary mechanical circulatory support (MCS) is frequently used for CS-AMI stabilization.

Purpose of the Study:

  • To assess the efficacy and complications of CF-LVAD implantation in CS-AMI patients.
  • To evaluate outcomes after stabilization with temporary mechanical support.
  • To determine the long-term survival and complication profile of CF-LVADs in this high-risk population.

Main Methods:

  • Retrospective analysis of nine CS-AMI patients who received CF-LVADs (Heartmate II or HVAD) between January 2006 and November 2014.
  • All patients required prior temporary MCS and were classified as Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1.
  • Data collected included time from MI to CF-LVAD implant, survival rates, and post-operative complications.

Main Results:

  • Seven out of nine patients (78%) survived to discharge.
  • Long-term survival rates at 1, 3, 12, and 48 months were 100%, 89%, 67%, and 67%, respectively.
  • The most frequent complication was stroke (55%), with mild embolic strokes and higher mortality associated with hemorrhagic strokes.

Conclusions:

  • CF-LVADs represent a potential, albeit high-risk, treatment option for select CS-AMI patients stabilized with temporary support.
  • Two patients were successfully bridged to heart transplantation, and four remain alive on device support.
  • Further research is needed to clarify the precise benefits and risks of CF-LVADs in the CS-AMI population.

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