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07:39
Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
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Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience
Bryan G Schwartz1, Daniel J Ludeman1, Guy S Mayeda2
1Heart Institute, Good Samaritan Hospital, Los Angeles, California, USA.
Cardiology Research
|March 29, 2017
Summary
New percutaneous left ventricular assist devices (PLVADs) like Impella and TandemHeart show successful initiation in cardiogenic shock patients. These devices may benefit the heart during myocardial infarction, warranting further randomized trials.
Area of Science:
- Cardiology
- Interventional Cardiology
- Mechanical Circulatory Support
Background:
- Intra-aortic balloon pumps (IABPs) are standard for cardiogenic shock (CS).
- The clinical utility of newer percutaneous left ventricular assist devices (PLVADs), specifically Impella and TandemHeart, remains largely unknown in CS management.
- This study aimed to describe the institutional use of PLVADs in CS patients.
Purpose of the Study:
- To evaluate the use and outcomes of Impella and TandemHeart devices in patients experiencing cardiogenic shock.
- To compare the effectiveness and complication rates of PLVADs against traditional IABP therapy.
- To assess the impact of PLVADs on myocardial function and overall mortality in CS.
Main Methods:
- Retrospective review of all cardiogenic shock cases utilizing PLVADs (Impella, TandemHeart) between January 2008 and June 2010.
- Analysis of patient demographics, device initiation success, co-interventions like percutaneous revascularization, and complication rates.
- Assessment of changes in ejection fraction and overall patient mortality.
Main Results:
- 76 cases were identified: 50 IABP only, 7 Impella, 19 TandemHeart. Most PLVAD patients were initially on IABP before device "upgrade".
- All devices were successfully initiated. High angiographic success rates (90%) were observed during percutaneous revascularization in 63 patients.
- Major complication rates were similar, though bleeding was less frequent with IABP. Ejection fraction improved significantly (P < 0.001). Overall mortality was 40%.
Conclusions:
- Impella and TandemHeart devices are successfully initiated in CS patients, supporting high-risk percutaneous interventions.
- These PLVADs may offer myocardial benefits during myocardial infarction.
- Randomized trials are essential to investigate the efficacy of Impella and TandemHeart in CS, particularly in patients refractory to IABP therapy.
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