Left Ventricular Assist Devices for Acute Myocardial Infarct Size Reduction: Meta-analysis

• Published in: Journal of cardiovascular translational research Vol. 14; no. 3; pp. 467 - 475
• Main Authors: Miyashita, Satoshi, Kariya, Taro, Yamada, Kelly P., Bikou, Olympia, Tharakan, Serena, Kapur, Navin K., Ishikawa, Kiyotake
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2021
• Subjects: Animals; Biomedical Engineering and Bioengineering; Biomedicine; Cardiology; Disease Models, Animal; Heart-Assist Devices; Human Genetics; Medicine; Medicine & Public Health; Myocardial Infarction - pathology; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocardium - pathology; Original Article; Prosthesis Design; Prosthesis Implantation - adverse effects; Prosthesis Implantation - instrumentation; Ventricular Function, Left; Infarct size; Ischemia reperfusion injury; LV unloading; Mechanical circulatory support
• ISSN: 1937-5387; 1937-5395; 1937-5395
• DOI: 10.1007/s12265-020-10068-7

We conducted a meta-analysis of preclinical studies that tested left ventricular assist device (LVAD) therapy for reducing myocardial infarct size in experimental acute myocardial infarction (AMI). Twenty-six articles were included with a total of 488 experimental animal subjects. The meta-analysis showed that infarct size was significantly decreased by LVAD support compared to control animals (SDM, − 2.19; 95% CI, − 2.70 to − 1.69; P  < 0.001). The meta-regression analysis demonstrated a high degree of heterogeneity associated with time from coronary artery occlusion to LVAD support, which correlated positively with infarct size. Subgroup analysis suggested smaller infarct size in LVAD therapies that withdrew blood from left heart than those from right heart. The proportion of left ventricular support relative to total cardiac output was positively correlated with infarct size reduction in Impella studies. Thus, early initiation of LVAD after ischemia and effective left ventricular venting may be important factors to reduce infarct size in AMI.