Assisted circulation using the TandemHeart during very high-risk PCI of the unprotected left main coronary artery in patients declined for CABG.
OBJECTIVE
In a single center experience, we retrospectively evaluated the short-term safety and efficacy of the TandemHeart percutaneous transseptal left ventricular assist (PTVA) system to deliver extracorporeal circulatory support during catheter based treatment of the unprotected left main coronary artery (ULMCA).


BACKGROUND
Percutaneous Coronary Intervention (PCI) of the ULMCA usually has been restricted to patients who are hemodynamically unstable or ineligible for coronary artery bypass grafting (CABG). High-risk patients for CABG should be considered at increased risk for PCI as well. In these patients the TandemHeart PTVA System (p-LVAD) may provide a valuable safeguard to reduce procedural risks.


RESULTS
Between July 2002 and May 2008 the TandemHeart was used in 9 very high risk patients (Logistic Euro score: 13.64 (7.46-29.67); Syntax score:43 (41-50); Mayo Clinic Risk score (MCRS) 7 (6-8); age: median 65 (range 55-71) undergoing elective PCI for the novo lesions on the ULMCA. All patients were declined for CABG by a heart team. A ''true'' percutaneous insertion technique was used in all patients, technical success rate was 100%. The median (range) time for implementation of circulatory support was 27 min (24-30). A median (range) pump flow up to 4.36 (3.40-5.54) L/min was achieved with significant reduction of left ventricular filling pressures, pulmonary capillary wedge pressure and a small increase of systemic arterial pressures. Median (range) duration of support was 93 min (50.4-102). Successful weaning was achieved in all patients. There was no in hospital death, survival at 6 months was (89%), whereas vascular access site complications were seen in 4 patients (44.4%).


CONCLUSIONS
In very high risk PCI, assisted circulation using the TandemHeart-PTVA provides effective, total left ventricular support and may contribute to a reduced procedural risk and improved survival. The rate of device related cardiac and vascular complications was acceptable.
Department of Cardiac Intensive Care and Interventional Cardiology, Virga Jesseziekenhuis Hartcentrum, Hasselt, Belgium.
Pascal
P
Vranckx
Carl Johann
CJ
Schultz
Marco
M
Valgimigli
Janette A
JA
Eindhoven
Arie P
AP
Kappetein
Evelin S
ES
Regar
Ron
R
Van Domburg
Patrick W
PW
Serruys
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation; D000075202:Contraindications; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000628:therapy*; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D018579:Patient Selection; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome