TandemHeart Device as Rescue Therapy in the Management of Acute Heart Failure

Authors

  • Siyamek Neragi-Miandoab
  • Daniel Goldstein
  • David A. D'Alessandro

DOI:

https://doi.org/10.1532/HSF98.2014348

Abstract

Background: The TandemHeart device (THD) is a pump system that can be deployed percutaneously (PC) or via conventional surgical (CS) cannulation; it is capable of supporting one or both ventricles. It is a versatile system designed for use as a rescue device in acute heart failure and as a bridge to decision in moribund patients.

Methods: Retrospective analysis was conducted on all patients who underwent a THD implant; either PC or CS; at our institution. Univariate analysis was done using Fisher's exact and Chi-square tests for categorical variables and Wilcoxon Rank Sum test for continuous ones.

Results: 51 adult patients were identified: 10 PC and 41 CS. Mean age was 58.9 ± 12.8 years, and 31% were female. In hospital mortality was 61%. Univariate predictors of death were prolonged support (74% versus 46%, P = .04) and higher lactic acid levels (5.3 ± 4.9 versus 2.3 ± 1.9 mmol/L, P = .012). The length of stay (LOS) for survivors was 59.8 ± 30.0 days.

Conclusion: Uni- or bi-ventricular unloading can be successfully achieved using the THD, either trans-thoracically or percutaneously, with an acceptable complication profile.

References

Bara C, Ghodsizad A, Kar B, Gregoric ID, Lichtenberg A, et al. 2007. A novel mechanical circulatory approach for patients with cardiogenic shock in the intensive care unit. Heart Surg Forum 10:E170-2.nBrinkman WT, Rosenthal JE, Eichhorn E, Dewey TM, Magee MJ, et al. 2009. Role of a percutaneous ventricular assist device in decision making for a cardiac transplant program. Ann Thorac Surg 88:1462-6.nBruckner BA, Jacob LP, Gregoric ID, Loyalka P, Kar B. 2008. Clinical experience with the TandemHeart percutaneous ventricular assist device as a bridge to cardiac transplantation. Tex Heart Inst J 35:447-50.nBurkhoff D, Klotz S, Mancini DM. 2006. LVAD-induced reverse remodeling: basic and clinical implications for myocardial recovery. J Card Fail 12:227-39.nBusch J, Torre-Amione G, Noon GP, Loebe M. 2008. TandemHeart insertion via a femoral arterial GORE-TEX graft conduit in a high-risk patient. Tex Heart Inst J 35:462-5.nChandra D, Kar B, Idelchik G, Simpson L, Loyalka P, Gregoric ID, et al. 2007. Usefulness of percutaneous left ventricular assist device as a bridge to recovery from myocarditis. Am J Cardiol 99:1755-6.nEntwistle JW 3rd, Bolno PB, Holmes E, Samuels LE. 2003. Improved survival with ventricular assist device support in cardiogenic shock after myocardial infarction. Heart Surg Forum 6:316-9.nGoldstein D, Neragi-Miandoab S. 2011. Mechanical bridge to decision: what are the options for the management of acute refractory cardiogenic shock? Curr Heart Fail Rep 8:51-8.nGregoric ID, Jacob LP, La Francesca S, Bruckner BA, Cohn WE, et al. 2008. The TandemHeart as a bridge to a long-term axial-flow left ventricular assist device (bridge to bridge). Tex Heart Inst J 35:125-9.nGregoric ID, Loyalka P, Radovancevic R, Jovic Z, Frazier OH, Kar B. 2009. TandemHeart as a rescue therapy for patients with critical aortic valve stenosis. Ann Thorac Surg 88:1822-6.nKar B, Adkins LE, Civitello AB, Loyalka P, Palanichamy N, et al. 2006. Clinical experience with the TandemHeart percutaneous ventricular assist device. Tex Heart Inst J 33:111-5.nKar B, Gregoric ID, Basra SS, Idelchik GM, Loyalka P, et al. 2011. The percutaneous ventricular assist device in severe refractory cardiogenic shock. J Am Coll Cardiol 57:688-96.nKhalife WI, Kar B. 2007. The TandemHeart pVAD in the treatment of acute fulminant myocarditis. Tex Heart Inst J 34:209-13.nKiernan M S, Krishnamurthy B, Kapur NK. 2010. Percutaneous right ventricular assist via the internal jugular vein in cardiogenic shock complicating an acute inferior myocardial infarction. J Invasive Cardiol 22:E23-6.nNeragi-Miandoab S. 1999. Zur Bedeutung der Therapie mit ACE-Hemmern bei experimenteller Herzinsuffizienz. Dissertation, ed. A.-L.-U.F.i. Breisgau. Freiburg, Germany: Albert-Ludwigs-Universität Freiburg im Breisgau. Vol. 1. 46.nNeragi-Miandoab S. 2012. A ventricular assist device as a bridge to recovery, decision making, or transplantation in patients with advanced cardiac failure. Surg Today 42:917-26.nNeragi-Miandoab S, Goldstein D, Bello R, Michler R, D'Alessandro D, et al. 2012. Right ventricular dysfunction following continuous flow left ventricular assist device placement in 51 patients: predicators and outcomes. J Cardiothorac Surg 7: 60.nPitsis AA, Visouli AN, Burkhoff D, Dardas P, Mezilis N, et al. 2007. Feasibility study of a temporary percutaneous left ventricular assist device in cardiac surgery. Ann Thorac Surg 84:1993-9.nThomas JL, Al-Ameri H, Economides C, Shareghi S, Abad DG, et al. 2010. Use of a percutaneous left ventricular assist device for high-risk cardiac interventions and cardiogenic shock. J Invasive Cardiol 22: 360-4.nVranckx P, Schultz CJ, Valgimigli M, Eindhoven JA, Kappetein AP, et al. 2009. Assisted circulation using the TandemHeart during very high-risk PCI of the unprotected left main coronary artery in patients declined for CABG. Catheter Cardiovasc Interv 74:302-10.nWindecker S. 2007. Percutaneous left ventricular assist devices for treatment of patients with cardiogenic shock. Curr Opin Crit Care 13:521-7.n

Published

2014-07-03

How to Cite

Neragi-Miandoab, S., Goldstein, D., & D’Alessandro, D. A. (2014). TandemHeart Device as Rescue Therapy in the Management of Acute Heart Failure. The Heart Surgery Forum, 17(3), E160-E162. https://doi.org/10.1532/HSF98.2014348

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