Left ventricular assist device bridge therapy for acute myocardial infarction

Abstract

Background. Patients with acute myocardial infarction (AMI) complicated by cardiogenic shock have a high mortality rate. Current treatment modalities remain suboptimal for these patients.Methods. From April 1995 to March 1998, 7 patients were identified as having AMI associated with cardiogenic shock. All received intraaortic balloon pump assistance, in addition to maximal inotropic support.Results. The mean preoperative cardiac index was 2.0 ± 0.3 L/min/m2 and pulmonary capillary wedge pressure was 23 ± 6 mm Hg. Three patients received thrombolytic therapy and 4 patients underwent percutaneous transluminal coronary angioplasty without success. Left ventricular assist devices (LVADs) were implanted as bridge therapy to heart transplantation. One patient died from recurrence of a ventricular septal defect during LVAD support. Six patients were transplanted successfully after mean LVAD support of 59 ± 33 days. Five patients are alive and well at a mean follow-up of 898 ± 447 days. One patient died 3 days after transplantation from acute allograft dysfunction.Conclusions. Timely application of LVADs as bridge therapy to heart transplantation in these critically ill patients can be lifesaving, and should be investigated further.