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J Thorac Cardiovasc Surg 2005;130:693-698
© 2005 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Left ventricular assist device implantation after acute anterior wall myocardial infarction and cardiogenic shock: A two-center study

^a Division of Cardiothoracic Surgery, Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, NY
^b Division of Cardiac Surgery, Department of Surgery, Brigham & Women's Hospital, Boston, Mass.

Received for publication December 7, 2004; revisions received March 25, 2005; accepted for publication April 12, 2005.

^_* Address for reprints: Yoshifumi Naka, MD, PhD, Herbert Irving Assistant Professor of Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Columbia University, College of Physicians and Surgeons, 177 Fort Washington Ave, Milstein Hospital, 7GN-435, New York, NY 10032. (Email: yn33{at}columbia.edu).

OBJECTIVE: Left ventricular assist device (LVAD) insertion after anterior wall myocardial infarction complicated by cardiogenic shock is an accepted modality of support in select patients. Results of primary revascularization for these patients are poor. We seek to determine the outcomes of patients with myocardial infarction and shock who undergo LVAD insertion alone versus surgical revascularization before LVAD insertion.

METHODS: Seventy-four patients at 2 institutions underwent LVAD implantation for myocardial infarction and shock over a 12-year period. Twenty-eight underwent direct LVAD placement, and 46 underwent revascularization through coronary artery bypass grafting before LVAD placement. Variables examined included patient demographics, myocardial infarction–LVAD interval, bridge to transplantation, early mortality (30 days), survival after LVAD placement, and posttransplantation survivals.

RESULTS: There were no differences in demographics between the 2 groups. The group undergoing revascularization before LVAD placement had a lower bridge to transplantation, higher early mortality, and lower overall 6- and 12-month survivals after LVAD placement compared with the group undergoing direct LVAD placement (45.50% vs 70.40%, P = .041; 39.10% vs 14.30%, P = .020; 89.3% and 82.1% vs 54.4% and 52.2%, respectively, P = .006). Posttransplantation survival and LVAD explantation rates were equivalent in both groups.

CONCLUSIONS: Coronary artery bypass grafting before LVAD insertion for cardiogenic shock complicating myocardial infarction adversely affects survival. Confirmation of these findings would require conducting a large, multicenter, randomized clinical trial comparing revascularization versus LVAD support as primary therapy in this setting.

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