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

Abstract

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;

Advanced Percutaneous Mechanical Circulatory Support Devices for Cardiogenic Shock

“…30 In simulated models, TandemHeart provides support intermediate between Impella 2.5 and Impella 5.0. 21 Similar to Impella, TandemHeart reduces cardiac workload by decreasing LV pressures and volumes (Figure 2B), 15 although, placement high in the aorta could increase afterload and offset LV unloading, 31 especially in low cardiac output states.…”

Diagnosis and management of acute heart failure

“…Disadvantages are vascular entrance complications and limited flow (94). Despite the fact that percutaneous VADs are applied successfully in cardiogenic shock after AMI and early survival rate is around 70%, superiority of percutaneous VADs over IABP was not supported adequately by randomized trials (95, 96). …”

Myocardial revascularisation in high-risk subjects

“…The TandemHeart was also associated with an improvement in haemodynamics and cardiac output in patients with cardiogenic shock secondary to MI 150. Despite this, there was no difference in 30-day mortality when compared with IABP, but instead more bleeding and vascular complications 151…”