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 havin g AMI associated with cardiogenic shock. All received intraaortic balloon p ump assistance, in addition to maximal inotropic support. Results. The mean preoperative cardiac index was 2.0 +/- 0.3 L/min/m(2) and pulmonary capillary wedge pressure was 23 +/- 6 mm Hg. Three patients rece ived thrombolytic therapy and 4 patients underwent percutaneous translumina l coronary angioplasty without success. Left ventricular assist devices (LV ADs) were implanted as bridge therapy to heart transplantation. One patient died from recurrence of a ventricular septal defect during LVAD support. S ix 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 allograf t dysfunction. Conclusions. Timely application of LVADs as bridge therapy to heart transpl antation in these critically ill patients can be lifesaving, and should be investigated further. (C) 2000 by The Society of Thoracic Surgeons.