Use of the TandemHeart percutaneous ventricular assist device to support patients undergoing high-risk percutaneous coronary intervention.
OBJECTIVE
We describe our experience in using the TandemHeart percutaneous ventricular assist device (pVAD) during high-risk percutaneous coronary intervention (PCI).


BACKGROUND
Coronary artery bypass grafting (CABG) is the preferred treatment for disease in an unprotected left main coronary artery or left main equivalent. However, severe comorbidities may preclude surgery in some patients. In these cases, PCI is also often a high-risk procedure. The pVAD is designed to provide circulatory support during high-risk PCI.


RESULTS
We used the pVAD for hemodynamic support during PCI in 5 consecutive patients who were ineligible for CABG because of severe comorbidities. In all 5 cases, the device was inserted and support initiated without complications. Percutaneous revascularization was successfully performed with pVAD support (approximately 3 L per minute). Four patients were supported for an average of 107 minutes, the pVAD being withdrawn shortly after PCI; all 4 patients recovered uneventfully. The fifth patient required support for 48 more hours after the procedure because of poor ventricular function. He died of heart failure and severe mitral regurgitation 10 days after pVAD withdrawal.


CONCLUSIONS
The pVAD may provide sufficient circulatory support for hemodynamic protection during high-risk PCI, thus improving morbidity and mortality and broadening the therapeutic options for high-risk patients. Further investigation of this device is warranted.
Kar
Biswajit
B
Cardiovascular Transplant Service and the Cardiovascular Research Laboratories of the Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas, USA.
Forrester
Matthew
M
Gemmato
Courtney
C
Civitello
Andrew
A
Loyalka
Pranav
P
Myers
Timothy
T
Reynolds
Delgado
D
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome