title: Use of a percutaneous left ventricular assist device for high-risk cardiac interventions and cardiogenic shock.
abstract: OBJECTIVE
  We sought to describe the use of the TandemHeart percutaneous left ventricular assist device (PVAD) in a group of high-risk patients undergoing complex cardiovascular procedures.
  
  
  BACKGROUND
  There is a substantial risk of acute decompensation and death in patients with cardiogenic shock or a reduced cardiac reserve undergoing high-risk cardiovascular interventions. The TandemHeart PVAD provides near-total hemodynamic support in this setting.
  
  
  METHODS
  Thirty-seven high-risk patients underwent placement of the TandemHeart PVAD during 38 separate procedures between April 2007 and April 2009. PVAD insertion was considered emergent if a patient was not expected to survive more than 6 hours without PVAD support. Technical success was defined as successful initiation of the PVAD and completion of the intended interventional procedure.
  
  
  RESULTS
  All 37 patients were in cardiogenic shock or undergoing complex coronary and valvular interventions with a high probability of hemodynamic collapse. The mean (+/- standard deviation) patient age was 73 +/- 14 years; 97% were in either NYHA class III-IV heart failure or cardiogenic shock; and the mean EuroSCORE was 11 +/- 3.4. Indications for ventricular assist device placement included critical aortic stenosis (n = 8), severe left main coronary stenosis (n = 18), severe multivessel coronary stenosis (n = 19) and severe cardiomyopathy (n = 23). Four patients were being managed for fulminant myocarditis, ventricular free-wall rupture, flail mitral valve or severe paravalvular leak. Despite their critical status and frequent (82%) need for post-procedure blood transfusion, this complex and high-risk patient population tolerated PVAD-supported intervention well and technical success was achieved in all patients. Seventy-one percent of patients survived to hospital discharge with improved functional status. Most deaths occurred in patients not expected to survive due to their moribund status and multiorgan failure.
  
  
  CONCLUSIONS
  This experience demonstrates the utility and effectiveness of TandemHeart PVAD support in patients with advanced disease, critical clinical status and limited therapeutic options.
authors.affiliation: Division of Cardiology, Good Samaritan Hospital, Los Angeles, California, USA.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Thomas
authors.forename: Hazim
authors.initials: H
authors.lastname: Al-Ameri
authors.forename: Christina
authors.initials: C
authors.lastname: Economides
authors.forename: Shahrzad
authors.initials: S
authors.lastname: Shareghi
authors.forename: Damian Grovas
authors.initials: DG
authors.lastname: Abad
authors.forename: Guy
authors.initials: G
authors.lastname: Mayeda
authors.forename: Steven
authors.initials: S
authors.lastname: Burstein
authors.forename: David M
authors.initials: DM
authors.lastname: Shavelle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000601:surgery; D009202:Cardiomyopathies / Q000453:epidemiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000453:epidemiology / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000601:surgery; D009205:Myocarditis / Q000453:epidemiology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome