The contemporary utilization of TandemHeart® in Severe Cardiogenic Shock and Acute Decompensated Heart Failure
Main Article Content
Abstract
Severe cardiogenic shock in the setting of acute decompensated heart failure, refractory to aggressive pharmacologic intervention is synonymous with high mortality. Recent innovative advancements in mechanical circulatory system [MCS] has provided some semblance of hope, with use exponentially increasing due to the favorable outcomes. These devices serve as bridge towards definitive therapy by providing hemodynamic stability. The TandemHeart® (LivaNova Inc) has gained increased notoriety due to the increased degree of support provided in in left ventricular failure. A nationwide shock database analysis found increased mortality benefits of TandemHeart® over Impella®. However, there continues to remain scarce data and limited clinical trials demonstrating the efficacy of TandemHeart® over other devices. We present three assorted cases of cardiogenic shock refractory to Impella® successfully managed with the TandemHeart® system. We discuss the indication, utility, and the potential benefits provided by the TandemHeart® system including ability to add oxygenator in circuit, ease to convert to VA-ECMO, use in prosthetic aortic valve, and capable of offloading left atrium and left ventricle.
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
2. van Diepen S, Katz JN, Albert NM, et al. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation. Oct 17 2017;136(16):e232-e268. doi:10.1161/CIR.0000000000000525
3. Vahdatpour C, Collins D, Goldberg S. Cardiogenic Shock. J Am Heart Assoc. Apr 16 2019;8(8):e011991. doi:10.1161/JAHA.119.011991
4. Telukuntla KS, Estep JD. Acute Mechanical Circulatory Support for Cardiogenic Shock. Methodist Debakey Cardiovasc J. Jan-Mar 2020;16(1):27-35. doi:10.14797/mdcj-16-1-27
5. Wong ASK, Sin SWC. Short-term mechanical circulatory support (intra-aortic balloon pump, Impella, extracorporeal membrane oxygenation, TandemHeart): a review. Ann Transl Med. 2020 Jul;8(13):829. doi: 10.21037/atm-20-2171. PMID: 32793674; PMCID: PMC7396256.
6. Ergle K, Parto P, Krim SR. Percutaneous Ventricular Assist Devices: A Novel Approach in the Management of Patients With Acute Cardiogenic Shock. Ochsner J. Fall 2016;16(3):243-9.
7. DiVita M, Visveswaran GK, Makam K, et al. Emergent TandemHeart-ECMO for acute severe mitral regurgitation with cardiogenic shock and hypoxaemia: a case series. Eur Heart J Case Rep. Feb 2020;4(1):1-6. doi:10.1093/ehjcr/ytz234
8. Kar B, Adkins LE, Civitello AB, et al. Clinical experience with the TandemHeart percutaneous ventricular assist device. Tex Heart Inst J. 2006;33(2):111-5.
9. Naidu SS. Novel percutaneous cardiac assist devices: the science of and indications for hemodynamic support. Circulation. Feb 8 2011;123(5):533-43.
doi:10.1161/CIRCULATIONAHA.110.945055
10. Burkhoff D, Cohen H, Brunckhorst C, O'Neill WW, TandemHeart Investigators G. A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock. Am Heart J. Sep 2006;152(3):469 e1-8. doi:10.1016/j.ahj.2006.05.031
11. Khalid Y, Dasu N, Dasu K, Suga H. Impella versus TandemHeart in Cardiogenic Shock Nationwide Database Analysis 2017. J Am Coll Cardiol. May 2021; 77 (18_Supplement_1) 818. doi:10.1016/S0735-1097(21)02177-X
12. Holger Thiele, Alexander Jobs, Dagmar M Ouweneel, Jose P S Henriques, Melchior Seyfarth, Steffen Desch, et al. Percutaneous short-term active mechanical support devices in cardiogenic shock: a systematic review and collaborative meta-analysis of randomized trials, European Heart Journal, Volume 38, Issue 47, 14 December 2017, Pages 3523–3531, https://doi.org/10.1093/eurheartj/ehx363
13. Bruckner BA, Jacob LP, Gregoric ID, Loyalka P, Kar B, Cohn WE, et al. Clinical experience with the TandemHeart percutaneous ventricular assist device as a bridge to cardiac transplantation. Tex Heart Inst J. 2008;35(4):447-50. PMID: 19156239; PMCID: PMC2607106.
14. Pahuja M, Johnson A, Kabir R, Bhogal S, Wermers JP, Bernardo NL, Ben-Dor I, Hashim H, Satler LF, Sheikh FH, Waksman R. Randomized Trials of Percutaneous Microaxial Flow Pump Devices: JACC State-of-the-Art Review. J Am Coll Cardiol. 2022 Nov 22;80(21):2028-2049. doi: 10.1016/j.jacc.2022.08.807. PMID: 36396205.
15. Schwartz BG, Ludeman DJ, Mayeda GS, Kloner RA, Economides C, Burstein S. High-risk percutaneous coronary intervention with the TandemHeart and Impella devices: a single-center experience. J Invasive Cardiol. 2011 Oct;23(10):417-24. PMID: 21972160.
16. Kar B, Adkins LE, Civitello AB, Loyalka P, Palanichamy N, Gemmato CJ, Myers TJ, Gregoric ID, Delgado RM 3rd. Clinical experience with the TandemHeart percutaneous ventricular assist device. Tex Heart Inst J. 2006;33(2):111-5. PMID: 16878609; PMCID: PMC1524679.