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

Jonathan M. Chen, Joseph J. Derose, James Slater, Talia B. Spanier, Todd M. Dewey, Katherine A. Catanese, Margaret A. Flannery, Mehmet C. Oz

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1903-1908
Number of pages6
JournalJournal of the American College of Cardiology
Volume33
Issue number7
DOIs
StatePublished - Jun 1 1999
Externally publishedYes

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Heart-Assist Devices
Survival Rate
Myocardial Infarction
Hemodynamics
Mortality
Shock
Nitric Oxide
Transplantation
Demography

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Chen, Jonathan M. ; Derose, Joseph J. ; Slater, James ; Spanier, Talia B. ; Dewey, Todd M. ; Catanese, Katherine A. ; Flannery, Margaret A. ; Oz, Mehmet C. / Improved survival rates support left ventricular assist device implantation early after myocardial infarction. In: Journal of the American College of Cardiology. 1999 ; Vol. 33, No. 7. pp. 1903-1908.
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abstract = "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.",
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Improved survival rates support left ventricular assist device implantation early after myocardial infarction. / Chen, Jonathan M.; Derose, Joseph J.; Slater, James; Spanier, Talia B.; Dewey, Todd M.; Catanese, Katherine A.; Flannery, Margaret A.; Oz, Mehmet C.

In: Journal of the American College of Cardiology, Vol. 33, No. 7, 01.06.1999, p. 1903-1908.

Research output: Contribution to journalArticle

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T1 - Improved survival rates support left ventricular assist device implantation early after myocardial infarction

AU - Chen, Jonathan M.

AU - Derose, Joseph J.

AU - Slater, James

AU - Spanier, Talia B.

AU - Dewey, Todd M.

AU - Catanese, Katherine A.

AU - Flannery, Margaret A.

AU - Oz, Mehmet C.

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N2 - 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.

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