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DOI: 10.1055/s-2005-861951
Long-term mechanical circulatory support for cardiogenic shock following acute myocardial infarction: single-center 10-year experience
Objectives: Patients with acute myocardial infarction (AMI) complicated by cardiogenic shock have a high mortality rate. Circulatory support devices can be used to save these patients.
Methods: From 08–1994 to 01–2004, 21 patients (4 female and 17 male) were identified as having AMI associated with cardiogenic shock. Seven patients suffered from 1-vessel disease, and 14 patients had two or more coronary arteries affected. Eight patients received IABP assistance, in addition to maximal inotropic support. Three patients had thrombolytic therapy and six patients underwent PTCA without success prior to surgery. Eight patients required cardiopulmonary reanimation. Left ventricular assist devices (LVADs) were implanted as bridge therapy to heart transplantation using NOVACOR (3), TCI (4), DeBakey (4), Thoratec (2), INCOR (4) and EXCOR (4) devices.
Results: Four patients died from intracranial bleedings, in five patients death was caused by right heart failure, and three patients suffered from multi-organ failure. Seven patients were transplanted successfully after an average support interval of 181 days. One patient is still under LVAD support and one patient could be weaned from the device after 96 days. Overall mortality rate was 57%. Mortality Rate in patients with a pulsatile device was 46% and 75% in patients with a non-pulsatile devices (p<0.05). Patients with single vessel disease had a significant better outcome than those where two or more vessels were affected (14% vs. 71% mortality rate, p<0.05).
Conclusion: Timely application of LVADs can be lifesaving. Patients with single vessel disease seem to have a better outcome than patients where two or more vessels are affected. Pulsatile support has been associated with a slightly better outcome.