title: Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience.
abstract: BACKGROUND
  Patients with cardiogenic shock (CS) are routinely treated with intra-aortic balloon pumps (IABPs). The utility of 2 new percutaneous left ventricular assist devices (PLVADs), the Impella and TandemHeart, is unknown. The objective of this study was to describe the use of PLVADs for patients with CS at our institution.
  
  
  METHODS
  All cases involving PLVADs in patients with CS between between January 1, 2008 and June 30, 2010 at a private, tertiary referral hospital were reviewed retrospectively.
  
  
  RESULTS
  All 76 cases were identified (50 IABP only, 7 Impella, 19 TandemHeart). Most Impella (5/7) and TandemHeart (10/19) patients were initially treated with an IABP before "upgrading" for increased hemodynamic support. All 76 devices (100%) were initiated successfully. Percutaneous revascularization was attempted in 63 patients with angiographic success in 57 (90%). The incidences of major complications were similar between groups, except bleeding occurred less frequently with the IABP. Mean ejection fraction on presentation was 30.4±16.5% and increased by a mean of 6.6±11.4% (P < 0.001). With the institutional approach of treating patients with CS initially with vasopressors and IABPs, then upgrading to an Impella or TandemHeart device for patients refractory to IABP therapy, the overall mortality rate was 40%.
  
  
  CONCLUSIONS
  The Impella and TandemHeart devices can be initiated successfully in patients with CS, are associated with high rates of angiographic success during high risk percutaneous interventions and may benefit the myocardium during myocardial infarction. Randomized trials are warranted investigating use of the Impella and TandemHeart devices in patients with CS and in patients refractory to conventional IABP therapy.
authors.affiliation: Heart Institute, Good Samaritan Hospital, Los Angeles, California, USA.
authors.forename: Bryan G
authors.initials: BG
authors.lastname: Schwartz
authors.affiliation: Heart Institute, Good Samaritan Hospital, Los Angeles, California, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ludeman
authors.affiliation: Department of Cardiology, Good Samaritan Hospital, Los Angeles, California, USA.
authors.forename: Guy S
authors.initials: GS
authors.lastname: Mayeda
authors.affiliation: Heart Institute, Good Samaritan Hospital, Los Angeles, California, USA; Department of Internal Medicine, Division of Cardiovascular Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kloner
authors.affiliation: Department of Cardiology, Good Samaritan Hospital, Los Angeles, California, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Economides
authors.affiliation: Department of Cardiology, Good Samaritan Hospital, Los Angeles, California, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Burstein
keywords: Cardiogenic shock; Cardiopulmonary resuscitation; Heart failure; Heart-assist devices; Hemodynamics; Myocardial infarction