Safety and efficacy of left ventricular assist device support in postmyocardial infarction cardiogenic shock.
BACKGROUND
Cardiogenic shock secondary to acute myocardial infarction (CS-AMI) is the leading cause of death in all acute coronary syndromes. Experience with the use of left ventricular assist devices (LVADs) in patients with CS-AMI is limited. One of the surgical dilemmas when implanting an LVAD into a patient with an acute anterior wall myocardial infarction is the safety of apical cannulation. We present a decade of experience with the use of LVAD with apical cannulation in patients with CS-AMI.


METHODS
A retrospective review of the ventricular assist device (VAD) database at the Hospital of the University of Pennsylvania was instituted.


RESULTS
From April 1995 to February 2005, 49 patients received LVAD support for CS-AMI (group I). The majority of these patients suffered anterior wall myocardial infarctions. This group of patients was compared with a separate cohort of 61 patients with chronic ischemic cardiomyopathy who received LVAD support (group II). The VAD support successfully bridged 38 (74%) group I patients and 37 (61%) group II patients to heart transplantation. Of the 38 patients transplanted in group I, 33 (87%) were discharged from the hospital. In group II, 36 of the 37 patients transplanted (97%) survived to hospital discharge. The overall in-hospital mortality rates for the series were 33% for group I patients, and 41% for group II patients.


CONCLUSIONS
Left ventricular assist device support in patients with CS-AMI is a safe and effective therapy which should be incorporated into the standard treatment paradigm for appropriate patients presenting with this lethal disease.
Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Bradley G
BG
Leshnower
Thomas G
TG
Gleason
Mary Lou
ML
O'Hara
Alberto
A
Pochettino
Y Joseph
YJ
Woo
Rohinton J
RJ
Morris
Timothy J
TJ
Gardner
Michael A
MA
Acker
D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D012189:Retrospective Studies; D012449:Safety; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate