Rationale for the use of ventricular assist devices in myocardial infarction: A narrative review

Acta Colombiana de Cuidado Intensivo Pub Date : 2025-04-01 DOI:10.1016/j.acci.2025.01.003

Juan Sanjuan , Kevin Gómez , Pamela Pabon , Gustavo Adolfo Villegas-Gomez

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Abstract

Cardiogenic shock (CS) complicates 5–10% of myocardial infarction (MI) cases and remains a significant challenge despite advances in pharmacologic and revascularization techniques. Ventricular assist devices (VADs) have emerged as critical tools to improve hemodynamic stability, reduce myocardial workload, and enhance survival outcomes in these patients.

This narrative review analyzed 61 studies from 2010 to 2024, focusing on the role of VADs in MI-related CS. Data were obtained from PubMed, Medline, and Cochrane Library, emphasizing device efficacy, complications, and clinical outcomes. Inclusion criteria targeted randomized trials, observational studies, and meta-analyses evaluating intra-aortic balloon pumps, Impella, TandemHeart, and ECMO.

VADs provide varying degrees of circulatory support, with Impella and TandemHeart outperforming intra-aortic balloon pumps in reducing myocardial workload. ECMO offers comprehensive support but carries higher risks of complications such as limb ischemia and infection. Early VAD deployment improves survival, particularly in patients with INTERMACS profiles 1 and 2. However, complications such as bleeding, thrombosis, and infection remain prevalent, requiring precise patient selection and timely intervention.

VADs represent an evolving paradigm in the management of MI complicated by CS. While their benefits are evident, challenges related to complications and high costs persist. Continued innovation in device design, patient stratification protocols, and therapeutic integration is essential to optimize outcomes.

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在心肌梗死中使用心室辅助装置的理由：一个叙述性的回顾

心源性休克（CS）并发症占心肌梗死（MI）病例的5-10%，尽管在药理学和血运重建技术方面取得了进展，但仍是一个重大挑战。心室辅助装置（VADs）已成为改善这些患者血液动力学稳定性、减少心肌负荷和提高生存结果的关键工具。本文回顾性分析了2010年至2024年的61项研究，重点研究了vad在mi相关CS中的作用。数据来自PubMed、Medline和Cochrane图书馆，强调器械的疗效、并发症和临床结果。纳入标准针对评估主动脉内球囊泵、Impella、TandemHeart和ECMO的随机试验、观察性研究和荟萃分析。vad提供不同程度的循环支持，Impella和TandemHeart在减少心肌负荷方面优于主动脉内球囊泵。ECMO提供全面的支持，但有较高的并发症风险，如肢体缺血和感染。早期部署VAD可提高生存率，特别是在INTERMACS特征1和2的患者中。然而，出血、血栓形成和感染等并发症仍然普遍存在，需要精确的患者选择和及时干预。VADs代表了一种不断发展的管理模式，在心肌梗死合并CS。虽然它们的好处显而易见，但与并发症和高成本相关的挑战仍然存在。器械设计、患者分层方案和治疗整合方面的持续创新对于优化结果至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Colombiana de Cuidado Intensivo

CiteScore

0.50

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0.00%

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