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Abstract
BackgroundExtracorporeal left ventricular assist device is often required for acute myocardial infarction patients in cardiogenic shock when temporary mechanical circulatory support fails to provide hemodynamic stabilization. This study aimed to evaluate the clinical outcomes of acute myocardial infarction patients in cardiogenic shock supported by an extracorporeal left ventricular assist device.MethodsThis retrospective study enrolled 13 acute myocardial infarction patients in cardiogenic shock treated with an extracorporeal left ventricular assist device from April 2011 to July 2020.ResultsTwelve (92.3%) and eleven (84.6%) patients were supported using venoarterial extracorporeal membrane oxygenation and intra-aortic balloon pumping before implantation, respectively. The median duration from acute myocardial infarction to extracorporeal left ventricular assist device implantation was 7 (3.5–24.5) days. The overall in-hospital mortality rate was 30.8% (n = 4). Extracorporeal left ventricular assist device was explanted in one patient for cardiac recovery; eight (61.5%) patients were approved as heart transplant candidates in whom the extracorporeal left ventricular assist device was exchanged for a durable left ventricular assist device; two (15.4%) expired while waiting for a heart transplant, and two (15.4%) received a successful transplant. The 1- and 3-year overall survival rates after extracorporeal left ventricular assist device implantation were 68.3% and 49.9%, respectively.ConclusionsThe operative mortality after extracorporeal left ventricular assist device implantation in acute myocardial infarction patients in cardiogenic shock was favorable. Our strategy of early hemodynamic stabilization with extracorporeal left ventricular assist device implantation in these patients as a bridge-to-bridge therapy was effective in achieving better survival.
Highlights
Extracorporeal left ventricular assist device is often required for acute myocardial infarction patients in cardiogenic shock when temporary mechanical circulatory support fails to provide hemodynamic stabilization
Our strategy has shifted towards an early administration of extracorporeal left ventricular assist device (LVAD) implantation for maximum circulatory support for circulatory failing patients under a temporary mechanical circulatory support to avoid the development of end-organ dysfunction among acute myocardial infarction (AMI) patients in cardiogenic shock
Value given as number (%) or median eLVAD, extracorporeal left ventricular assist device; AMI, acute myocardial infarction; RVAD, right ventricular assist device; CABG, coronary artery bypass grafting; ECMO, extracorporeal membrane oxygenation
Summary
Extracorporeal left ventricular assist device is often required for acute myocardial infarction patients in cardiogenic shock when temporary mechanical circulatory support fails to provide hemodynamic stabilization. This study aimed to evaluate the clinical outcomes of acute myocardial infarction patients in cardiogenic shock supported by an extracorporeal left ventricular assist device. AMI in cardiogenic shock is one of the most challenging diseases despite recent medical advances, and when these temporary mechanical circulatory support systems fail to provide hemodynamic stabilization, patients are considered candidates for extracorporeal left ventricular assist device (LVAD) implantation as this device provides stronger systemic flow support and improves the left ventricular unloading. Our strategy has shifted towards an early administration of extracorporeal LVAD implantation for maximum circulatory support for circulatory failing patients under a temporary mechanical circulatory support to avoid the development of end-organ dysfunction among AMI patients in cardiogenic shock
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