title: The TandemHeart as a bridge to a long-term axial-flow left ventricular assist device (bridge to bridge).
abstract: End-stage heart-failure patients in acute refractory cardiogenic shock with multi-organ dysfunction require aggressive medical therapy that includes inotropic support. Historically, the intra-aortic balloon pump was the last option for patients who were dying of acute cardiogenic shock. Short-term extracorporeal pulsatile or nonpulsatile cardiac assist devices or extracorporeal membrane oxygenation offered further treatment options; however, these therapies required invasive surgical procedures. Patients in this high-risk group had increased mortality rates from major procedures that required cardiopulmonary bypass. We used the TandemHeart, a percutaneously implanted device for short-term cardiac assistance, to lower the risk of death and improve hemodynamic performance and end-organ perfusion before implanting long-term assist devices in selected patients with signs of profound cardiogenic shock. Nine end-stage heart-failure patients (mean age, 37.7 yr) in acute refractory hemodynamic decompensation received a percutaneously implanted TandemHeart pump as a bridge to an implantable axial-flow pump. To determine the relative risk for these patients, prognostic scores were calculated before and after insertion of the TandemHeart. Percutaneous support times ranged from 1 to 22 days (mean, 5.9 d). The mean cardiac index before support, 1.02 L/(min.m2) (range, 0.0-1.8 L/[min.m2]) (0.0 L/[min.m2] implies active cardiopulmonary resuscitation), improved to 2.97 L/(min.m2) (range, 2.2-4.0 L/[min.m2]) during support. Three patients underwent successful cardiac transplantation; 5 are currently supported by axial-flow pumps; and 1 died of complications unrelated to the axial-flow pump, after 587 days. End-organ function and overall condition improved uniformly in our patients, thus decreasing the preoperative risk factors for implantation of the long-term device.
authors.affiliation: Department of Cardiopulmonary Transplantation and Mechanical Circulatory Support, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
authors.forename: Igor D
authors.initials: ID
authors.lastname: Gregoric
authors.forename: Leon P
authors.initials: LP
authors.lastname: Jacob
authors.forename: Saverio
authors.initials: S
authors.lastname: La Francesca
authors.forename: Brian A
authors.initials: BA
authors.lastname: Bruckner
authors.forename: William E
authors.initials: WE
authors.lastname: Cohn
authors.forename: Pranav
authors.initials: P
authors.lastname: Loyalka
authors.forename: Biswajit
authors.initials: B
authors.lastname: Kar
authors.forename: O H
authors.initials: OH
authors.lastname: Frazier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004867:Equipment Design; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D013318:Stroke Volume; D016896:Treatment Outcome