The TandemHeart as a bridge to a long-term axial-flow left ventricular assist device (bridge to bridge)

Igor D. Gregoric, Leon P. Jacob, Saverio La Francesca, Brian A. Bruckner, William E. Cohn, Pranav Loyalka, Biswajit Kar, O. H. Frazier

Research output: Contribution to journalArticle

55 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)125-129
Number of pages5
JournalTexas Heart Institute Journal
Volume35
Issue number2
StatePublished - 2008

Keywords

  • Cardiac output, low/mortality/therapy
  • Cardiomyopathies
  • Heart failure/mortality/therapy
  • Heart-assist devices/design/standards/statistics & numerical data
  • Prostheses and implants
  • Risk management
  • Severity of illness index

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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