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Updated: Jun 19, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Role of a percutaneous ventricular assist device in decision making for a cardiac transplant program
William T Brinkman1, Jed E Rosenthal, Eric Eichhorn
1Medical City Dallas Hospital, Dallas, Texas 75230, USA. wbrinkman@csant.com
Insights
The percutaneous TandemHeart (percTH) ventricular assist device offers reliable left heart support for cardiogenic shock patients. It is effective for bridge to transplant and bridge to decision, minimizing adverse events.
Area of Science:
- Cardiology
- Medical Devices
- Mechanical Circulatory Support
Background:
- The role of percutaneous ventricular assist devices (VADs) for left heart support in cardiogenic shock remains unclear.
- Percutaneous left ventricular (LV) support aims to stabilize patients with severe heart failure.
Purpose of the Study:
- To evaluate the safety and efficacy of the percutaneous TandemHeart (percTH) ventricular support device for LV support.
- To assess the outcomes of patients managed with percTH for cardiogenic shock, including bridge to decision (BTD) and bridge to transplant (BTT) strategies.
Main Methods:
- Retrospective review of all patients who received LV support with the percutaneous TandemHeart (percTH) device.
- Analysis of implantation indications (BTD or salvage, BTT), duration of support, device performance, and clinical outcomes.
Main Results:
- 22 percTH devices were implanted in patients with isolated left heart failure between April 2005 and December 2008.
- No mechanical device failures, infections, or cerebrovascular accidents occurred.
- 10 of 11 BTT patients were successfully bridged to transplant; 4 BTD patients were successfully explanted.
Conclusions:
- The percutaneous TandemHeart (percTH) device demonstrated reliability with minimal adverse events.
- PercTH is a valuable option for bridge to decision, allowing for patient evaluation without the risks of long-term VADs.
Background:
The role of a percutaneous ventricular assist device (VAD) for left heart support in the management of patients in cardiogenic shock is not well defined.
Methods:
All patients who received LV support using the percutaneous TandemHeart (percTH) ventricular support device (Cardiac Assist, Pittsburgh, PA) were retrospectively reviewed. Indications for insertion included bridge to decision (BTD) or "salvage" and bridge to transplant (BTT).
Results:
Between April 2005 and December 2008, 22 percTH devices were successfully implanted in patients (13 men) with isolated left heart failure. Mean duration of support was 6.8 +/- 9.4 days (median, 4; maximum, 45 days). Of patients requiring percTH support for at least 3 days, mean pump flows were 3.77 +/- 1.10, 4.22 +/- 0.69, and 4.04 +/- 0.41 L/min on at days 1, 2, and 3. Mean serum aspartate aminotransferase levels were 455 +/- 994 mg/dL before percTH, 551 +/- 1046 mg/dL at day 1, and 231 +/- 225 mg/dL at day 3 after percTH. No mechanical device failure, device-related infections, or cerebrovascular accidents occurred. Ten of 11 BTT patients were successfully bridged. Support was withdrawn in 7 of 11 BTD patients. The percTHs were successfully explanted in 4 BTD patients: 1 as recovery, 1 direct to transplant, and 2 to VAD.
Conclusions:
The percTH was reliable, with no mechanical device failures and minimal associated adverse events. We support the use of the percTH in the BTD mode, allowing time for a more complete evaluation of neurologic and end-organ status without the added expense and morbidity of a long-term VAD.
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