Upgrade to Central Extracorporeal Life Support for Salvage of Left Main Occlusion-Induced Cardiogenic Shock.

Acute myocardial infarction (MI) due to left main coronary artery occlusion leads to poor outcomes, despite intensive treatments using extracorporeal life support (ECLS). We hypothesized that morbidity and mortality related to this pathology may be reduced by upgrade from peripheral to central ECLS, in which inflow directly from the cardiac chamber is connected to the ascending aorta through the blood pump with or without oxygenator. This study enrolled a consecutive institutional series of 61 cases who were treated with peripheral ECLS for acute MI induced by left main coronary artery occlusion between April 2013 and October 2020. The average age was 64±14-year-old, and male patients consist of 77%. Modes of peripheral ECLS, such as IABP, Impella devices or veno-arterial ECMO were optimized according to the hemodynamics. While 39 cases received continued peripheral ECLS, the remaining 22 cases (36%) whose peripheral ECLS was suboptimum were upgraded to central ECLS following 2.9 days of peripheral ECLS. There was 22 in-hospital death (56%) in the peripheral group and 11 in the central group (50%, p=0.79). The major cause of mortality in the peripheral group was low output syndrome in 9 (53%), cerebrovascular accident (CVA) in 4 (24%). In contrast, in the central group, 3 (23%) died of CVA and 3 (23%) died of septicemia. Of 11 surviving cases in the central group, eight cases were further upgraded to the durable LVAD for bridge to transplantation. In the remaining 3 cases in the central group, ESLS was discontinued for palliative care. Cox proportional hazard regression analysis detected that high CK-MB (over 570 IU/ml) but not central ECLS was an independent risk factor of death. In conclusion, upgrade to central ECLS avoided mortality associated with suboptimum peripheral ECLS for left main occlusion-induced cardiogenic shock. Life-long mechanical circulatory support is inevitable in cases who need upgrade to central ECLS. [ABSTRACT FROM AUTHOR]