Improved survival rates support left ventricular assist device implantation early after myocardial infarction

• Published in: Journal of the American College of Cardiology Vol. 33; no. 7; pp. 1903 - 1908
• Main Authors: Chen, Jonathan M, DeRose, Joseph J, Slater, James P, Spanier, Talia B, Dewey, Todd M, Catanese, Katherine A, Flannery, Margaret A, Oz, Mehmet C
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01-06-1999; Elsevier Science
• Subjects: Adult; Aged; Biological and medical sciences; Cardiology. Vascular system; Coronary heart disease; Follow-Up Studies; Heart; Heart-Assist Devices; Hemodynamics; Humans; Medical sciences; Middle Aged; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Prognosis; Prosthesis Implantation; Retrospective Studies; Survival Rate; RVAD; IABP; MSOF; TCI; CABG; MI; LVAD; Human; Prognosis; Infarct; Acute; Cardiocirculatory support; Cardiovascular disease; Instrumentation; Coronary heart disease; Myocardial disease; Left ventricle; Treatment; Implanted; Myocardium; Early; Technique
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(99)00132-1

OBJECTIVES
Implantation of left ventricular assist devices (LVADs) early after acute myocardial infarction (MI) has traditionally been thought to be associated with high mortality rates due to technical limitations and severe end-organ dysfunction. At some experienced centers, doctors have refrained from earlier operation after MI to allow for a period of hemodynamic and end-organ stabilization.
METHODS
We retrospectively investigated the effect of preoperative MI on the survival rates of 25 patients who received a Thermocardiosystems Incorporated LVAD either <2 weeks (Early) (n = 15) or >2 weeks (Late) (n = 10) after MI. Outcome variables included perioperative right ventricular assistance (and right-sided circulatory failure), hemodynamic indexes, percent transplanted or explanted, and mortality.
RESULTS
No statistically significant differences were demonstrated between demographic, perioperative or hemodynamic variables between the Early and Late groups. Patients in the Early group demonstrated a lower rate of perioperative mechanical right ventricular assistance, but had a higher rate of perioperative inhaled nitric oxide use. In addition, 67% of patients in the Early group survived to transplantation and 7% to explantation, findings comparable to those in the Late group (60% and 0% respectively).
CONCLUSIONS
This clinical experience suggests that patients may have comparable outcomes whether implanted early or late after acute MI. These data therefore support the early identification and timely application of this modality in post-MI LVAD candidates, as this strategy may also reveal a subgroup of patients for whom post-MI temporary LVAD insertion may allow for full ventricular recovery.