TandemHeart as a rescue therapy for patients with critical aortic valve stenosis

We analyzed our use of the TandemHeart Percutaneous Ventricular Assist Device (Cardiac Assist Inc, Pittsburgh, PA) as a rescue therapy for patients with cardiac arrest or severe refractory cardiogenic shock (SRCS) before or after aortic valve replacement (AVR) for critical aortic valve stenosis.

We reviewed the records of 10 patients (6 men; 4 women), aged 62 +/- 12 years, who presented with cardiac arrest or SRCS. Eight patients, 5 undergoing cardiopulmonary resuscitation (CPR) and 3 with SRCS, received TandemHeart support in the catheterization laboratory and had AVR after undergoing hemodynamic stabilization. The other 2 patients went directly to the operating room while undergoing CPR, for emergency AVR and received the device for postcardiotomy cardiogenic shock. All 10 patients were intubated, on maximal vasopressor support, and 7 had an intraaortic balloon pump. The preoperative Society of Thoracic Surgeons mortality risk was 74.9% +/- 24.5%.

The 8 patients who received the TandemHeart in the catheterization laboratory were supported for 6.4 +/- 3.8 days and had significantly improved renal function before AVR. One patient died of sepsis 34 days after AVR, The other 7 were discharged home (ejection fraction, 0.42 +/- 0.14) and were alive 2 to 43 months later. The 2 patients who received the device in the operating room after AVR died on days 8 and 21, respectively.

Prompt placement of the TandemHeart in these critically ill patients yields the shortest "emergency department door to left ventricular unloading time," improves end-organ function, and allows AVR to be performed electively.