Assisted circulation using the TandemHeart® during very high‐risk PCI of the unprotected left main coronary artery in patients declined for CABG

Vranckx, Pascal; Schultz, Carl; Valgimigli, Marco; Eindhoven, Janette A.; Kappetein, Arie Pieter; Regar, Evelin S.; Domburg, Ron van; Serruys, Patrick W.

doi:10.1002/ccd.22011

Cited by 39 publications

(27 citation statements)

References 19 publications

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“…The hemodynamic effects have been studied in patients undergoing high-risk PCI (552). Several small studies have addressed the clinical efficacy of the TandemHeart in high-risk patients undergoing PCI (551,(553)(554)(555)(556). In a single-center report of 68 patients undergoing high-risk PCI using either TandemHeart or Impella Recover 2.5, success rates (Ͼ90%) and vascular complications (7%) were similar (553).…”

Section: Embolic Protection Devices: Recommendationmentioning

confidence: 99%

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

Levine¹,

Bates²,

Blankenship³

et al. 2011

Journal of the American College of Cardiology

1,978

480

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Section: Embolic Protection Devices: Recommendationmentioning

confidence: 99%

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

Levine¹,

Bates²,

Blankenship³

et al. 2011

Journal of the American College of Cardiology

1,978

480

View full text Add to dashboard Cite

“…Experience of elective implantation of TandemHeart ahead of high-risk PCI has been reported in several observational studies [40] [41] [42] [43]. These studies, although small, confirm that TandemHeart is technically feasible and may provide excellent hemodynamic support.…”

Section: Tandemheart In High-risk Pcimentioning

confidence: 96%

Use of Left Ventricular Support Devices During Acute Coronary Syndrome and Percutaneous Coronary Intervention

Spiro

Doshi

2014

Curr Cardiol Rep

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In an effort to improve outcomes in percutaneous coronary intervention (PCI), percutaneous ventricular assist devices (PVADs) have been investigated in (1) high-risk PCI, (2) acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) and (3) in AMI without CS. PCI has become an increasing complex due to an ageing population with complex disease and the frequent presence of impaired LV function. Patients undergoing high-risk PCI in these circumstances are prone to acute cardiovascular collapse. Additionally, mortality in AMI complicated by CS remains high. Lastly, LV support during AMI may reduce infarct size and therefore preserve LV function. At present, four commercially available devices exist: intra-aortic balloon pump counterpulsation (IABP), Impella, TandemHeart and extracorporeal membrane oxygenation (ECMO). These devices are employed in an effort to increase cardiac output, mean arterial pressure (MAP) and coronary perfusion and to reduce pulmonary capillary wedge pressure (PCWP). The mechanism of action differs with each device, and there are advantages and disadvantages. In this update, we discuss recent data describing the use of PVADs to support patients with AMI with or without cardiogenic shock and during high-risk PCI. We focus on the unique features of each device, highlighting strengths, weaknesses and frequently encountered complications, which may be important when tailoring the most appropriate PVAD therapy to an individual patient's need.

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“…6 Currently, 2 FDA approved percutaneous ventricular assist devices, the Impella and the Tandem Heart, are available offering superior hemodynamic support compared with traditional intra-aortic balloon pump counterpulsation. 7,8 Both these devices present their own benefits and challenges, each requiring expertise in vascular access and deployment. Physician and support team expertise is also required to manage these devices during the PCI and in the postprocedural time period.…”

Section: Bassmentioning

confidence: 99%

High-Risk Percutaneous Coronary Interventions in Modern Day Clinical Practice

Bass

2015

Circ: Cardiovascular Interventions

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A t its inception, all percutaneous coronary interventions (PCI) were considered high risk. The initial US experience published by the National Heart, Lung, and Blood Institute Registry reported procedural success to be <60% and the need for emergent coronary bypass surgery occurring 6% of the time.1 It was mandatory to have a cardiothoracic surgeon immediately available and an operating room open and ready to go. These outcomes involving a far less complex, lower risk population compared with patients we currently treat would be completely unacceptable today. The evolution of coronary interventions has been remarkable during the past decades attributable to the refinement and development of new device technologies, imaging capabilities, adjunctive pharmacotherapies and the explosive growth in physician and catheterization laboratory team experience. This has resulted in a greatly expanded population who can now be treated by PCI, including sicker patients often with more complex anatomic lesions. Overall reported procedural success rates are now expected to approach 100% and complication rates continue to trend toward or <1%. With this history and in our current environment of expanding databases, public reporting, cost-sensitive resource use, and increased patient expectations, the concept and reality of high-risk PCI continues to evolve.First and foremost, it is helpful to differentiate complex PCI from high-risk PCI. The interventional cardiovascular community has spent a great deal of effort defining, classifying, and attempting to understand how to best treat patients presenting for complex PCI. The term complex PCI is a descriptor applied to patients presenting with complex, anatomic coronary lesions. These lesions may have a variety of defining characteristics such as severe calcification, extensive thrombotic burden, extreme tortuosity or length, or might be chronically, totally occluded. The lesion location might be located at a coronary bifurcation or in a degenerated saphenous venous bypass graft. Analysis derived from large registries have consistently demonstrated that PCI involving these anatomically complex lesions results in expected lower procedural success rates with an increased risk of procedural complications when compared with PCI of less anatomically complex coronary lesions. 2 We have successfully developed both the technology and interventional techniques to facilitate optimally treating these lesions.An example of a complex PCI might be a middle-aged male with normal left ventricular (LV) function and increasing angina presenting for PCI with a heavily calcified bifurcation lesion involving the left anterior descending-first diagonal bifurcation. This is indeed different from what should be considered as a high-risk PCI, which might involve the same angiographic lesion, but occurring in an elderly male with a chronically occluded right coronary artery and a severely decreased LV ejection fraction. Therefore, the approach, skill sets, and support systems required to do these interventi...

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Assisted circulation using the TandemHeart® during very high‐risk PCI of the unprotected left main coronary artery in patients declined for CABG

Abstract: 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.

Cited by 39 publications

References 19 publications

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

Use of Left Ventricular Support Devices During Acute Coronary Syndrome and Percutaneous Coronary Intervention

High-Risk Percutaneous Coronary Interventions in Modern Day Clinical Practice

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