Left ventricular assist device bridge therapy for acute myocardial infarction

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.