Temporary surgical ventricular assist device for treatment of acute myocardial infarction and refractory cardiogenic shock in the percutaneous device era

Background Acute myocardial infarction with refractory cardiogenic shock (AMI-RCS) is associated with poor outcomes. Several percutaneous mechanical circulatory support devices exist; however, limitations exist regarding long-term use. Herein, we describe our experience with the temporary surgical C...

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Bibliographic Details
Published in:Journal of artificial organs 2021-06, Vol.24 (2), p.199-206
Main Authors: Singh, Sameer K., Witer, Lucas, Kaku, Yuji, Masoumi, Amirali, Fried, Justin A., Yuzefpolskaya, Melana, Colombo, Paolo C., Sayer, Gabriel, Uriel, Nir, Naka, Yoshifumi, Takayama, Hiroo, Takeda, Koji
Format: Article
Language:English
Subjects:
Biomedical Engineering and Bioengineering
Cardiac Surgery
Heart attacks
Medicine
Medicine & Public Health
Myocardial infarction
Nephrology
Original Article
Shock
Transplantation
Ventricle
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Summary:Background Acute myocardial infarction with refractory cardiogenic shock (AMI-RCS) is associated with poor outcomes. Several percutaneous mechanical circulatory support devices exist; however, limitations exist regarding long-term use. Herein, we describe our experience with the temporary surgical CentriMag VAD. Methods We reviewed 74 patients with AMI-RCS who underwent CentriMag VAD insertion as bridge-to-decision device from 2007 to 2020. Patients were divided into groups based on introduction of the “shock team” model: Era 1 (2007–2014, n  = 51) and Era 2 (2015–2020, n  = 23). Results Era 2 had higher proportion of patients with INTERMACS Profile I. The use of percutaneous MCS as bridge to VAD and the use of minimally invasive VAD were higher in Era 2. There were fewer postoperative bleeding events in Era 2 (80% vs 61%, p  = .07). Thirty-day mortality was 23% and 1-year survival was 55%, which were no differences between eras. Destinations after CentriMag VAD included myocardial recovery (39%), durable LVAD (27%), and transplantation (5%). Conclusion CentriMag VAD device represents a viable bridge-to-decision device with acceptable short- and long-term outcomes for patients with AMI-RCS. Stable outcomes in a progressively sicker population may be related to changes in practice patterns as well as introduction of the “shock team” concept.
ISSN:1434-7229
1619-0904
DOI:10.1007/s10047-020-01236-2