Surgical outcomes of bridge-to-bridge therapy with extracorporeal left ventricular assist device for acute myocardial infarction in cardiogenic shock.

Abstract

BACKGROUND:

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.

METHODS:

This 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.

RESULTS:

Twelve (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.

CONCLUSIONS:

The 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.

• Authors: Chiho Tokunaga, Atsushi Iguchi, Hiroyuki Nakajima, Fumiya Chubachi, Yuto Hori, Akitoshi Takazawa, Jun Hayashi, Toshihisa Asakura, Akihiro Yoshitake
• Journal: BMC cardiovascular disorders (BMC Cardiovasc Disord) Vol. 22 Issue 1 Pg. 54 (02 16 2022) ISSN: 1471-2261 [Electronic] England
• PMID: 35172726 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s).

Topics

• Adolescent
• Adult
• Device Removal
• Extracorporeal Membrane Oxygenation (adverse effects, instrumentation, mortality)
• Female
• Heart Transplantation
• Heart-Assist Devices
• Hemodynamics
• Hospital Mortality
• Humans
• Male
• Middle Aged
• Myocardial Infarction (diagnosis, mortality, physiopathology, surgery)
• Prosthesis Design
• Recovery of Function
• Retrospective Studies
• Shock, Cardiogenic (diagnosis, mortality, physiopathology, surgery)
• Time Factors
• Time-to-Treatment
• Treatment Outcome
• Ventricular Function, Left
• Waiting Lists (mortality)
• Young Adult