title: Mechanical circulatory support for cardiogenic shock complicating acute myocardial infarction: an experimental and clinical review.
abstract: Cardiogenic shock (CS) occurs in 7% to 10% of cases after acute myocardial infarction and remains the most common cause of death in these patients. Despite aggressive treatment regimens such as fibrinolysis and percutaneous transluminal coronary angioplasty, mortality rates from CS remain extremely high. It has been shown that intra-aortic balloon pumping can result in initial hemodynamic stabilization. However, in the majority of studies, death was merely delayed. In recent years, efforts have been made to develop ventricular devices (LVAD) capable of providing complete short-term hemodynamic support. Seventeen major studies of LVAD support for CS complicating acute myocardial infarction are reported in the literature, with a mean weaning and survival rate of 58.5% and 40%, respectively. Patients considered in these studies are difficult to compare in terms of demographic and anatomic data, but taking these considerations into account, LVAD support seems to give no survival improvement in these patients compared with early reperfusion alone or associated with intra-aortic balloon pumping. Data emerging from experimental studies of acute myocardial infarction supported with LVAD are intriguing. In this review, we report the LVAD experience in the CS setting, starting from percutaneous extracorporeal support up to bridge therapy with implantable devices.
authors.affiliation: Cardiac Surgery Division, A. De Gasperis Department, Niguarda Ca'Granda Hospital, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Garatti
authors.forename: Claudio
authors.initials: C
authors.lastname: Russo
authors.forename: Marco
authors.initials: M
authors.lastname: Lanfranconi
authors.forename: Tiziano
authors.initials: T
authors.lastname: Colombo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bruschi
authors.forename: Salvatore
authors.initials: S
authors.lastname: Trunfio
authors.forename: Filippo
authors.initials: F
authors.lastname: Milazzo
authors.forename: Emanuele
authors.initials: E
authors.lastname: Catena
authors.forename: Paola
authors.initials: P
authors.lastname: Colombo
authors.forename: Frigerio
authors.initials: F
authors.lastname: Maria
authors.forename: Ettore
authors.initials: E
authors.lastname: Vitali
mesh_terms: D006353:Heart-Assist Devices; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D009203:Myocardial Infarction / Q000150:complications*; D012770:Shock, Cardiogenic / Q000209:etiology / Q000601:surgery* / Q000628:therapy*