Safety and efficacy of left ventricular assist device support in postmyocardial infarction cardiogenic shock

Background. Cardiogenic shock secondary to acute myocardial infarction ( CS- AMI) is the leading cause of death in all acute coronary syndromes. Experience with the use of left ventricular assist devices ( LVADs) in patients with CS- AMI is limited. One of the surgical dilemmas when implanting an LVAD into a patient with an acute anterior wall myocardial infarction is the safety of apical cannulation. We present a decade of experience with the use of LVAD with apical cannulation in patients with CS- AMI. Methods. A retrospective review of the ventricular assist device ( VAD) database at the Hospital of the University of Pennsylvania was instituted. Results. From April 1995 to February 2005, 49 patients received LVAD support for CS- AMI ( group I). The majority of these patients suffered anterior wall myocardial infarctions. This group of patients was compared with a separate cohort of 61 patients with chronic ischemic cardiomyopathy who received LVAD support ( group II). The VAD support successfully bridged 38 ( 74%) group I patients and 37 ( 61%) group II patients to heart transplantation. Of the 38 patients transplanted in group I, 33 ( 87%) were discharged from the hospital. In group II, 36 of the 37 patients transplanted ( 97%) survived to hospital discharge. The overall in- hospital mortality rates for the series were 33% for group I patients, and 41% for group II patients. Conclusions. Left ventricular assist device support in patients with CS- AMI is a safe and effective therapy which should be incorporated into the standard treatment paradigm for appropriate patients presenting with this lethal disease.