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Updated: May 25, 2025
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Case report: ST-elevation myocardial infarction complications. How far will you go?
Rumbinaitė Eglė1, Karčiauskas Dainius2,3, Jakuška Povilas2,3
1Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Insights
Managing ST-elevation myocardial infarction with cardiogenic shock requires a multidisciplinary approach. Mechanical circulatory support, like LVADs, can bridge patients to heart transplantation, but complications may arise.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- ST-elevation myocardial infarction (STEMI) with cardiogenic shock (CS) presents complex management challenges.
- Mechanical circulatory support (MCS) is a critical intervention, often bridging patients to heart transplantation (HTx).
- Prior interventions and complications can impact HTx candidacy in STEMI-CS patients requiring MCS.
Purpose of the Study:
- To review the multidisciplinary management of STEMI-CS.
- To highlight the role of MCS as a bridge to HTx.
- To discuss challenges in HTx candidacy for patients with prior interventions and MCS.
Main Methods:
- Case report of a 63-year-old male with out-of-hospital cardiac arrest due to acute anterior STEMI-CS.
- Emergency percutaneous coronary intervention and HeartMate 3 (HM3) left ventricular assist device (LVAD) implantation.
- Management of postoperative complications including infections and tracheal stenosis.
- Successful heart transplantation (HTx) following LVAD support.
Main Results:
- Successful revascularization and HM3 LVAD implantation.
- Patient weaned from mechanical ventilation post-LVAD implantation.
- Postoperative complications included infections and tracheal stenosis, managed appropriately.
- Successful HTx was performed after addressing complications.
Conclusions:
- A multidisciplinary team approach is crucial for managing STEMI-CS and its complications.
- MCS, specifically LVADs, can be effective bridges to HTx, even in complex cases.
- Careful management of complications is essential for successful HTx candidacy after MCS implantation.
Abstract:
Herein, we review the critical role of a multi-disciplinary team approach in managing the intricate complications of ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). Mechanical circulatory support (MCS) implantation represents a potentially life-saving intervention, often serving as a bridge to heart transplantation (HTx). However, complications from prior interventions, in patients receiving MCS due to STEMI-CS, may present additional challenges to successful HTx candidacy. A 63-year-old male suffered out-of-hospital cardiac arrest and was hospitalized due to acute anterior STEMI-CS. Emergency percutaneous coronary intervention was performed in the setting of cardiopulmonary resuscitation. Despite successful revascularization and subsequent optimal medical therapy hemodynamic status remained compromised, the decision was made to implant a HeartMate 3 (HM3) left ventricular assist device (LVAD) as a bridge to HTx. HM3 LVAD was implanted without complications and patient was weaned from mechanical ventilation. The later postoperative period was complicated by infections leading to the LVAD-related complications. Moreover, the patient experienced repeated episodes of stridor, which were attributed to significant tracheal stenosis (due to temporary tracheostomy). Finally, a suitable heart donor was found and a successful HTx was performed.
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