Permanent Continuous Flow Left Ventricular Assist Devices Use After Acute Stabilization for Cardiogenic Shock in Acute Myocardial Infarction.
Cardiogenic shock complicating acute myocardial infarctions (CS-AMIs) carries high mortality rates. Early use of durable continuous flow left ventricular assist devices (CF-LVAD) in these patients has traditionally been discouraged. Therefore we sought to assess the efficacy and complications of CF-LVAD use in CS-AMI after stabilization with temporary mechanical support. From January 2006 to November 2014, nine patients underwent CF-LVAD implant after CS-AMI (Heartmate II, six; HVAD, three). All patients required temporary mechanical circulatory support (MCS) before CF-LVAD implant and were interagency registry for mechanically assisted circulatory support profile 1; average time from MI to CF-LVAD implant was 20 days. Overall seven of nine patients (78%) survived to discharge. Survival at 1, 3, 12, and 48 months was 100%, 89%, 67%, and 67%, respectively. Two patients were successfully bridged to transplant and four patients remain alive on device support. The most common post-LVAD complication was stroke, occurring in 55% of patients. Embolic strokes were mild in severity and all patients survived with only mild deficits; hemorrhagic strokes conferred the highest mortality. This study suggests CF-LVADs are potential but high-risk treatment options for CS-AMI patients who stabilize with temporary support. Further studies will help more clearly delineate the benefits and risks of CF-LVAD implant in this population.
From 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.
Josephine
J
Chou
Christian
C
Bermudez
Robert
R
Kormos
Jeffrey
J
Teuteberg
D000328:Adult; D000368:Aged; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000401:mortality / Q000628:therapy*