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

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Abstract

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.

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Abbreviations

AMI:

Acute myocardial infarction

IABP

Intra-aortic balloon pump

LA:

Left atrium

LV:

Left ventricle

LVAD:

Left ventricular assist device

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

SD:

Standard deviation

SDM:

Standard difference of mean

STEMI–DTU:

Door-to-Unload ST–Elevation Myocardial Infarction

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Funding

This work was supported by NIH R01 HL139963 (K.I.), AHA-SDG 17SDG33410873 (K.I.). O.B. was supported by Deutsche Herzstiftung.

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Authors and Affiliations

  1. Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA

    Satoshi Miyashita, Taro Kariya, Kelly P. Yamada, Olympia Bikou, Serena Tharakan & Kiyotake Ishikawa

  2. CardioVascular Center for Research and Innovation, Tufts Medical Center, Boston, MA, USA

    Navin K. Kapur

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Correspondence to Kiyotake Ishikawa.

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Conflict of Interest

K.I. serves as a PI of a research grant to the Icahn School of Medicine from Abiomed Inc. T.K. is a recipient of fellowship sponsored by Abiomed Inc. N.K.K receives institutional grant support and consulting and speaker honoraria from Abiomed Inc., Abbott Inc., Boston Scientific Inc., Medtronic Inc., MD Start, and Precardia. The remaining authors have no disclosures to report.

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Miyashita, S., Kariya, T., Yamada, K.P. et al. Left Ventricular Assist Devices for Acute Myocardial Infarct Size Reduction: Meta-analysis. J. of Cardiovasc. Trans. Res. 14, 467–475 (2021). https://doi.org/10.1007/s12265-020-10068-7

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