Cardiogenic shock due to myocardial infarction: Surgical revascularisationwith centrifugal left ventricular assistance

Cardiogenic shock in the acute phase of myocardial infarction still carries a high mortality. In young patients who cannot be revascularised by angiop lasty, when medical therapy is failing, some workers recommend an energetic approach, even cardiac transplantation, often with the bridge of mechanica l cardiac assistance. This is not possible everywhere, thus preventing poss ible myocardial salvage and resulting in fairly high mortality. The authors report two cases in which endoluminal revascularisation was not possible and so complete surgical revascularisation with left ventricular assistance was chosen. The two patients survived and one was successfully t ransplanted electively. This management may be proposed in young patients w ith multiple occlusions of large coronary arteries in post-infarction cardi ogenic shock when medical management is failing despite intra-aortic balloo n pumping.