High-Risk Chronic Total Occlusion Percutaneous Coronary Interventions Assisted With TandemHeart

Hemodynamic support is increasingly utilized to avoid hemodynamic collapse during high-risk chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Intermediate-term outcomes of Tandem Heart (TH)-supported CTO-PCI have not been previously reported.

We retrospectively evaluated procedural and clinical outcomes in consecutive patients undergoing TH-assisted CTO-PCI at our institution from April 1, 2016 to January 30, 2019.

Thirteen TH-assisted CTO-PCIs (25%) were performed during the study period. TH was placed before the PCI in all procedures. The most common reason for hemodynamic support was the use of retrograde CTO-PCI technique in the setting of left ventricular dysfunction (38%). Eleven patients (92%) had decreased left ventricular function with severe congestive heart failure symptoms before the procedure. The CTO vessel treated was the right coronary artery in 38% of patients. Retrograde approach was utilized in 6 PCIs (46%). Technical success was achieved in 12 PCIs (92%) despite very complex and very difficult CTO lesions, as indicated by a median J-CTO score of 3 and Progress CTO score of 2. Procedural success was achieved in 10 patients (77%). TH was removed at the completion of PCI in 11 procedures (85%). There were no major bleeding complications; however, one patient developed arteriovenous fistula at the arterial cannula insertion site. One patient had coronary perforation with hemodynamic compromise requiring pericardiocentesis. One patient died of cardiogenic shock, secondary to right ventricular wall hematoma.

TH can be used for hemodynamic support during CTO-PCI to achieve a very high technical success rate.