Related Experiment Video
Updated: May 28, 2026
Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
High-risk percutaneous coronary intervention with the TandemHeart and Impella devices: a single-center experience
Bryan G Schwartz1, Daniel J Ludeman, Guy S Mayeda
1Heart Institute, Good Samaritan Hospital, Los Angeles, CA 90017-2395, USA. bschwartz15@hotmail.com
Insights
Prophylactic percutaneous left ventricular assist devices (PLVADs) like Impella and TandemHeart show high success rates during high-risk percutaneous coronary intervention (HR-PCI). A tiered approach to PLVAD use may optimize hemodynamic support and minimize complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Mechanical Circulatory Support
Background:
- Intra-aortic balloon pumps (IABPs) are standard for high-risk percutaneous coronary intervention (HR-PCI).
- The utility of newer devices like Impella and TandemHeart for prophylactic use in HR-PCI requires further clarification.
- This study evaluated prophylactic percutaneous left ventricular assist devices (PLVADs) in HR-PCI.
Purpose of the Study:
- To determine the baseline characteristics, hemodynamics, and outcomes of patients undergoing HR-PCI with prophylactic PLVADs.
- To assess the efficacy and safety of Impella and TandemHeart devices in this setting.
- To evaluate a tiered approach to PLVAD selection based on left ventricular failure risk.
Main Methods:
- Retrospective analysis of 50 patients undergoing prophylactic PLVAD during HR-PCI (2008-2010).
- Devices used included IABP, Impella, and TandemHeart, with a tiered approach based on risk.
- Data collected included baseline characteristics, procedural success, and clinical outcomes.
Main Results:
- High rates of successful device initiation (100%) and angiographic success (96%) were observed across all device types.
- In patients not in cardiogenic shock, low rates of death (2.6%), recurrent ischemia (8%), and stroke (0%) were reported.
- A significant increase in ejection fraction post-device removal suggested a beneficial effect on myocardial function.
Conclusions:
- Prophylactic use of Impella and TandemHeart in HR-PCI demonstrates high angiographic success and low complication rates.
- A risk-stratified, tiered approach to PLVAD selection may optimize hemodynamic support and minimize adverse events.
- Further research is warranted to confirm these findings and guide clinical practice.
Background:
Intra-aortic balloon pumps (IABPs) are indicated during high-risk percutaneous coronary intervention (HR-PCI) to reduce major procedural complications. The clinical utility of the newer Impella and TandemHeart devices is not clear. This study determined the baseline characteristics, hemodynamics, and outcomes of patients treated with prophylactic percutaneous left ventricular assist devices (PLVADs) during HR-PCI.
Methods:
A retrospective analysis at a private, tertiary referral hospital was conducted of all cases involving prophylactic PLVAD during HR-PCI between January 1, 2008 and June 30, 2010. General practice in this institution involves a tiered approach to PLVAD whereby patients with the least, intermediate, and highest risk of left ventricular failure are treated with an IABP, Impella, or TandemHeart, respectively.
Results:
Fifty cases were identified (5 IABP, 13 Impella, 32 TandemHeart). Mean ejection fraction was 31 ± 17%. All devices (100%) were initiated successfully. Angiographic success was achieved in 96% (80% IABP, 100% Impella, 97% TandemHeart). Of the 38 patients not in cardiogenic shock, death occurred in 1 (2.6%), recurrent ischemia in 3 (8%), and stroke in 0%. Shortly after device removal, systolic blood pressure (mean increase, +5 ± 22 mmHg) and ejection fraction (mean increase, +7.4 ± 11%; p = 0.0006) increased in all 3 groups, suggesting a beneficial effect on the myocardium.
Conclusions:
In patients undergoing HR-PCI with Impella and TandemHeart support, angiographic success was high and major complication rates were low. A tiered approach where patients with the least, intermediate, and highest risk of left ventricular failure are treated with an IABP, Impella, or Tandem- Heart, respectively, theoretically maximizes appropriate hemodynamic support and minimizes complications. Further studies are warranted.
Related Concept Videos
01:21Cardiac Catheterization II: Right Heart Catheterization
01:24Cardiac Catheterization III: Left Heart Catheterization