Use of an extracorporeal left ventricular assist system after acute myocardial infarction due to occlusion of the left main coronary artery.

A 35-year-old man presented to our institution one day after the onset of dyspnea. Coronary angiography revealed the occlusion of the left main trunk. The left main coronary artery and the left circumflex artery were recanalized, but he was hypotensive with low cardiac output. Even after he was placed on circulatory support with veno-arterial extracorporeal membrane oxygenation (ECMO), hemodynamic deterioration could not be reversed, and lung edema developed. The decision was made to use Toyobo LVAS. With institution of left ventricular assist system (LVAS), however, the patient's arterial saturation decreased. Peripheral veno-venous (V-V) ECMO was promptly established, and the patient's arterial saturation improved. On postoperative day 3, the patient was successfully weaned from V-V ECMO. He was extubated on postoperative day 28. The patient was recovered without any serious complications. Although echocardiography showed no substantial improvement in left ventricular function, his general condition is doing quite well with the assist of Toyobo LVAS. He is on rehabilitation program and awaiting heart transplantation.