Enhanced preservation of acutely ischemic myocardium with transseptal left ventricular assist

Fonger, James D.; Zhou, Yin; Matsuura, H; Aldea, Gabriel S.; Shemin, Richard J.

doi:10.1016/0003-4975(94)90547-9

Cited by 29 publications

(10 citation statements)

References 21 publications

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“…9 In previous animal studies, the atrial septal defects induced by left atrial cannulation during the use of a VAD have been shown to heal completely at the end of 4 to 6 weeks or result in a clinically insignificant left-to-right shunt. 10 This hypothesis was confirmed by the absence of a relevant left-to-right shunt after weaning the patients from the VAD.…”

Section: Thiele Et Alsupporting

confidence: 56%

“…Previous animal studies have demonstrated a substantial decrease in the size of acute myocardial infarction by use of these left VADs with or without recanalization of the infarct related artery. 10,16 Furthermore, left atrial-to-femoral arterial support results in an increased systemic blood pressure, which may favorably affect the imbalance between oxygen demand and supply of the jeopardized myocardium 17 and may lead to optimal tissue perfusion. However, little is known about the effects of a continuous flow in contrast to a pulsatile flow in coronary arteries.…”

Section: Effects Of Left Atrial-to-femoral Arterial Bypassmentioning

confidence: 99%

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Reversal of Cardiogenic Shock by Percutaneous Left Atrial-to-Femoral Arterial Bypass Assistance

et al. 2001

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Background-Recovery of myocardial function after revascularization of acutely occluded coronary arteries may require several days. During this critical time, patients in cardiogenic shock may have low output. A newly developed percutaneous left ventricular assist device (VAD) may offer effective treatment for these patients by providing active circulatory support. Methods and Results-Between May 2000 and May 2001, VADs were implanted in 18 consecutive patients who had cardiogenic shock after myocardial infarction. The device was connected to the patient's circulation by insertion of a 21F venous cannula into the left atrium by transseptal puncture; blood was returned to the iliac artery through an arterial cannula. Mean duration of cardiac assistance was 4Ϯ3 days. Mean flow of the VAD was 3.2Ϯ0.6 L/min. Before support, cardiac index was 1.7Ϯ0.3 L/min per m 2 and improved to 2.4Ϯ0.6 L/min per m 2 (PϽ0.001). Mean blood pressure increased from 63Ϯ8 mm Hg to 80Ϯ9 mm Hg (PϽ0.001). Pulmonary capillary wedge pressure, central venous pressure, and pulmonary artery pressure were reduced from 21Ϯ4, 13Ϯ4, and 31Ϯ8 mm Hg to 14Ϯ4, 9Ϯ3, and 23Ϯ6 mm Hg (all PϽ0.001), respectively. Overall 30-day mortality rate was 44%. Conclusions-A newly developed VAD can be rapidly deployed in the catheterization laboratory setting. This device provides up to 4.0 L/min of assisted cardiac output, which may aid to revert cardiogenic shock. The left ventricle is unloaded by diverting blood from the left atrium to the systemic circulation, making recovery more likely after an ischemic event. The influence of this device on long-term prognosis warrants further investigation. (Circulation. 2001;

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Section: Thiele Et Alsupporting

confidence: 56%

Section: Effects Of Left Atrial-to-femoral Arterial Bypassmentioning

confidence: 99%

Reversal of Cardiogenic Shock by Percutaneous Left Atrial-to-Femoral Arterial Bypass Assistance

et al. 2001

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“…In a canine model of myocardial infarction, compared with reperfusion alone, reperfusion during left ventricular unloading with the TandemHeart device significantly reduced infarct size and microvascular damage (P < 0.001 for each) [17]. Similarly, in an animal model of myocardial infarction with simulated bypass grafting, infarct size was reduced with an IABP and was further reduced with a TandemHeart-like device [18]. …”

Section: Discussionmentioning

confidence: 99%

Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience

et al. 2012

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BackgroundPatients 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.MethodsAll 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.ResultsAll 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%.ConclusionThe 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.

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“…Given simultaneous biventricular unloading when used concomitantly, any shunting that might occur could go underappreciated. Usually, the intraatrial septostomy caused by the Tandem Heart TM device, if not closed surgically at the time of more invasive support implantation, has been shown in animals to heal completely at the end of a 4-to 6-week period [12,13]. If persistent, it usually results in insignificant shunting in those eventually weaned off the Tandem Heart TM with no eventual LVAD placement.…”

Section: Discussionmentioning

confidence: 97%

Percutaneous closure of an iatrogenic atrial septal defect

Sur¹,

Pagani²,

Moscucci³

2009

Cathet Cardio Intervent

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The use of the Tandem Heart percutaneous ventricular assist device (Tandem Heart pVAD, Cardiac Assist technologies, Pittsburgh, PA) as a bridge to recovery or to other cardiopulmonary support systems has been rising. One requirement for placement of this device is an intraatrial septostomy which is usually closed during the surgical insertion of more permanent ventricular assist devices. We present a case of a 62-year-old man with a residual acquired atrial septal defect (ASD) from Tandem Heart placement, which could not be closed surgically during insertion of left and right ventricular assist devices. The patient remained intubated and hypoxemic after removal of his right ventricular assist device due to the presence of persistent right to left shunting. With closure of the ASD using an 8-mm Amplatzer septal occluder (ASO; AGA Medical Corp., Golden Valley, MN) the patient stabilized and was successfully extubated.

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Enhanced preservation of acutely ischemic myocardium with transseptal left ventricular assist

Cited by 29 publications

References 21 publications

Reversal of Cardiogenic Shock by Percutaneous Left Atrial-to-Femoral Arterial Bypass Assistance

Reversal of Cardiogenic Shock by Percutaneous Left Atrial-to-Femoral Arterial Bypass Assistance

Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience

Percutaneous closure of an iatrogenic atrial septal defect

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