Percutaneous mechanical cardiac assist in myocardial infarction. Where are we now, where are we going?

Abstract

Since its first clinical application in patients with cardiogenic shock (CS) in 1968, the intra aortic balloon pump (IABP) increasingly has been used for several clinical conditions requiring mechanical cardiac assistance. In current practice, IABP therapy is still the most accessible and most frequently used method of mechanical cardiac assistance. It is primarily being used as a therapeutic instrument for hemodynamic stabilization in left ventricular failure and cardiogenic shock, mainly in patients with myocardial infarction. Although IABP therapy showed to be effective for stabilization of hemodynamically compromised patients, it has failed to show any long-term survival benefit in any setting of acute myocardial infarction. The rapid developments in ventricular assist device technology have led to the availability of several percutaneous implantable left ventricular assist devices (LVADs). These more potent percutaneous LVADs herald a promising alternative therapeutic approach for mechanical cardiac assistance other than IABP therapy. This article reviews the current status, capabilities, limitations, and future perspectives of currently available percutaneous treatment options for mechanical cardiac assistance in acute myocardial infarction.

Efficacy and timing of intra-aortic counterpulsation in patients with ST-elevation myocardial infarction complicated by cardiogenic shock

“…Intra-aortic balloon counterpulsation is still the most used method of LV unloading and haemodynamic support in the catheterisation laboratory [5]. However, the use of IABP therapy concomitant to primary PCI remains controversial, due to lack of sufficient (randomised) scientific support, as evidenced recently by a meta-analysis from our group [10].…”

“…(nitric oxide synthase inhibitors), which lowered mortality [3,4]. With the development of new, perhaps more potent, mechanical cardiac assist devices, the role of IABP therapy in the management of CS in recent studies has again been of major interest [5][6][7][8][9]. Routine use of IABP therapy in the setting of high-risk STEMI is not supported by evidence from randomised trials, as shown in our recently published meta-analysis [10].…”

Supported High-Risk Percutaneous Coronary Intervention With the Impella 2.5 Device

“…PCI and other indications were the high complication rates and complex handling of earlier devices, such as the femoro-femoral cardiopulmonary support system, Hemopump (Medtronic, Minneapolis, Minnesota), and the Tandemheart (CardiacAssist, Pittsburgh, Pennsylvania) (1,10). Three small series of periprocedural Impella 2.5 support were encouraging with respect to safety and feasibility (2,4,5).…”

Biomarkers, imaging and interventions – going up hill

“…The need for a quick and effective assist has always been pushing us in these intense moments of struggle for the patient's life. An excellent review on the ''state-ofthe-heart'' of percutaneous cardiac assist for the treatment of myocardial infarction is given by Sjauw et al (4). The world of percutaneous ventricular assist has left its stagnant phase and is rapidly changing.…”