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CLINICAL STUDIES

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

^a Department of Surgery, Division of Cardiothoracic Surgery, Columbia-Presbyterian Medical Center, New York, New York, USA

Manuscript received May 21, 1998; revised manuscript received January 8, 1999, accepted February 25, 1999.

Reprint requests and correspondence: Dr. Jonathan M. Chen, Department of Surgery, Presbyterian Hospital #295, 622 West 168th Street, New York, New York 10032
jmc23{at}columbia.edu

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.

Abbreviations and Acronyms   CABG = coronary artery bypass graft proc   IABP = intra-aortic balloon pump   LVAD = left ventricular assist device   MI = myocardial infarction   MSOF = multisystem organ failure   RVAD = right ventricular assist device   TCI = Thermocardiosystems Incorporated

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