Microaxial Left Ventricular Assist Devices

Use of Mechanical Circulatory Support Devices Among Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock

“…Additional RCT evidence, which would help guide the selection, use, and timing of MCS devices in patients with AMI complicated by cardiogenic shock, could play a role in reducing hospital-level variation and improving patient outcomes as well as targeting these devices to patients who are most likely to find them beneficial. 26,29 Among patients with STEMI, we found increased odds of MCS device use but lower use of intravascular microaxial LVADs. Because patients with STEMI in general have more acute, unstable presentations and are more likely to have a cardiac arrest, it is not surprising that these patients often received MCS devices.…”

“…Differences in reimbursement for intravascular microaxial LVADs vs IABPs as well as other factors may also be associated with the observed use trends. Additional RCT evidence, which would help guide the selection, use, and timing of MCS devices in patients with AMI complicated by cardiogenic shock, could play a role in reducing hospital-level variation and improving patient outcomes as well as targeting these devices to patients who are most likely to find them beneficial …”

“…25 One reason for the substantial variation in hospital use of MCS devices may be the paucity of clinical study data demonstrating the clinical benefit of intravascular microaxial LVAD use among patients with AMI complicated by cardiogenic shock. 26 Existing RCTs do not show the benefits of IABP use in AMI with cardiogenic shock, 6,10 although recent large observational studies have found that intravascular microaxial LVAD use was associated with higher mortality compared with IABP use. 12,13 Intravascular microaxial LVADs were also significantly more expensive than IABPs, suggesting significant differences in total cost.…”