Cardiogenic Shock Due to Anterior St-Elevation Myocardial Infarction Following Extracorporeal Membrane Oxygenation, Heartmate 3 Implantation and Heart Transplantation.

Introduction Acute myocardial infarction (AMI) is a leading cause of morbidity and mortality in the developed world. It frequently leads to severe complications such as cardiogenic shock, clinical death and irreversible heart failure [1]. Case Presentation A 64-year-old patient with type 2 diabetes and dyslipidemia was treated after clinical death caused by AMI. Cardiopulmonary resuscitation was performed, coronary angiography revealed a thrombus in the left coronary artery trunk, aspiration and stenting were performed. With remaining unstable hemodynamics, the ECMO system was connected and continuous venovenous hemodiafiltration was initiated. The patient's condition improved, but the cardiac function deteriorated and HeartMate3 left ventricular assist device was implanted as a “bridge to heart transplantation.” Later, 4 episodes of sepsis (Serratia marcescens) were recorded against the background of longterm antibiotic therapy and peri-aortic cannula infection was confirmed with PET scan. The patient remained dependent on LV support, and his status was changed to the urgent heart transplant waiting list. A heart transplant was performed, after which the patient's infections, anemia, and pneumothorax were corrected. Due to immunosuppressing drugs during the first year post-surgery, the patient had frequent urinary tract infections and fungal and viral pneumonias, that were successfully treated ethiologically. Discussion Left ventricular assist devices (LVAD) are frequently used as a bridge-to-transplant therapy for patients awaiting a suitable donor organ [2]. Although it has positive effects on heart function LVAD can also have adverse effects such as bleeding, infection, pump thrombosis, right heart failure, device malfunction, and stroke [3]. However, the occurrence of LVAD complications does not have an impact on the outcome after heart transplantation [4]. Conclusions This case highlights the challenges of managing AMI with severe complications, where ECMO, LVAD, and heart transplantation were vital for survival and recovery.