Improved Survival with Ventricular Assist Device Support in Cardiogenic Shock after Myocardial Infarction
Background: Cardiogenic shock after acute myocardial infarction is associated with a very high mortality rate.
Methods: A retrospective review was performed of records of all patients supported with an Abiomed device at our institution between 1994 and 2002 to identify those patients who underwent device insertion for the treatment of acute myocardial infarction complicated by cardiogenic shock (AMI-CS).
Results: Seventeen patients who were suffering from AMI-CS and for whom medical management was failing were supported using the Abiomed BVS 5000. The average age of these patients was 57.6 years. Eleven patients were suffering primarily from left ventricular dysfunction and were supported with a left ventricular assist device (LVAD). Eight of these patients were weaned from device support, and 6 survived to hospital discharge (54%). In contrast, 6 patients presented with biventricular failure and were supported with biventricular VADs (BiVADs). None of these BiVAD patients could be weaned from device support. Two BiVAD patients underwent cardiac transplantation, and only one survived.
Conclusion: In the presence of left ventricular failure producing cardiogenic shock after myocardial infarction, LVAD support can produce a 54% survival rate in those patients who are failing medical management. However, in patients in biventricular failure after myocardial infarction, BiVAD support may be used to stabilize the patient until transplantation, but the overall prognosis remains poor.
Dauerman HL, Goldberg RJ, White K, et al. 2002. Revascularization, stenting, and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. Am J Cardiol 90:838-40.nHochman JS, Buller CE, Sleeper LA, et al. 2000. Cardiogenic shock complicating acute myocardial infarction--etiologies, management and outcome: a report from the SHOCK Trial Registry. J Am Coll Cardiol 36(suppl A):1063-70.nSamuels LE, Holmes EC, Thomas MP, et al. 2001. Management of acute cardiac failure with mechanical assist: experience with the ABIOMED BVS 5000. Ann Thorac Surg 71(suppl):S67-72.nSanborn TA, Sleeper LA, Bates ER, et al. 2000. Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. Should we emergently revascularize occluded coronaries for cardiogenic shock? J Am Coll Cardiol 36(suppl A):1123-9.nThiele H, Lauer B, Hambrecht R, Boudriot E, Cohen HA, Schuler G. 2001. Reversal of cardiogenic shock by percutaneous left atrial-to-femoral arterial bypass assistance. Circulation 104:2917-22.n
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