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Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
Percutaneous left ventricular assist device with TandemHeart for high-risk percutaneous coronary intervention: the
Oluseun O Alli1, Inder M Singh, David R Holmes
1The Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
Insights
High-risk percutaneous coronary intervention (PCI) using TandemHeart ventricular support is a viable option for patients unsuitable for surgery. This approach demonstrated high procedural success and survival rates, offering a safe alternative for complex coronary artery disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Coronary artery bypass grafting (CABG) is standard for severe coronary disease but not feasible for all patients.
- Standard percutaneous coronary intervention (PCI) is often inadequate for high-risk patients.
- A hybrid PCI approach with hemodynamic support offers a potential solution.
Purpose of the Study:
- To evaluate the use of the TandemHeart percutaneous left ventricular assist device during high-risk PCI.
- To assess the safety and efficacy of this approach in patients ineligible for traditional treatments.
Main Methods:
- Retrospective analysis of prospectively collected data from 54 patients undergoing high-risk PCI with TandemHeart support.
- Collection and analysis of hemodynamic and clinical data.
Main Results:
- The procedure demonstrated significant hemodynamic improvements, including increased cardiac output and decreased heart pressures.
- High procedural success (97%) and favorable survival rates (90% at 30 days, 87% at 6 months) were observed.
- Major vascular complications occurred in 13% of cases, with no cases of contrast-induced nephropathy or need for dialysis.
Conclusions:
- High-risk PCI with TandemHeart percutaneous left ventricular support is a viable strategy for select high-risk patients.
- This approach provides an effective therapeutic option for patients with complex coronary artery disease who are poor candidates for standard revascularization.
Background:
In patients with poor left ventricular function and severe left main or multivessel coronary disease, coronary artery bypass grafting (CABG) surgery has been the preferred therapy. However, a number of these patients are either inoperable or poor surgical candidates due to comorbid conditions and previous cardiac surgical procedures. These patients are generally poor candidates for standard percutaneous coronary intervention (PCI) techniques. A hybrid PCI approach with hemodynamic support may be a viable strategy for these patients. We report our experience using the TandemHeart percutaneous left ventricular assist device during high-risk PCI.
Methods:
Retrospective cross-sectional analysis of prospectively collected data in 54 patients undergoing high-risk PCI using the TandemHeart device for support. Hemodynamic and clinical data were collected and analyzed.
Results:
Baseline clinical characteristics were as follows: mean age 72 ± 1.7 years, males 78%, median ejection fraction 20%, mean serum creatinine 1.6 ± 0.3 2 mg/dL, recent myocardial infarction 52%, COPD 33%, previous CABG 50%, diabetes mellitus 41%, and hypertension 83%. The median SYNTAX score was 33, and the median Jeopardy score was 10. The predicted surgical revascularization mortality was 13% by the Society for Thoracic Surgery risk score and 33% by Euroscore. There was a significant decrease in right and left heart pressures (P < 0.05) with a concomitant increase in the cardiac output from 4.7 to 5.7 L/min (P = 0.03) during TandemHeart support. Left main and multivessel PCI was performed in 62% of patients, and rotablation was used in 48%. Procedural success rate was 97%, whereas 30-day and 6 month survival were 90% and 87%, respectively. Major vascular complications occurred in 13% of cases. None of our patients developed contrast induced nephropathy or needed dialysis.
Conclusions:
High-risk PCI with percutaneous left ventricular support using TandemHeart is a viable therapeutic strategy for a select subset of patients at very high risk with standard percutaneous revascularization techniques.
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