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The TandemHeart as a bridge to a long-term axial-flow loft ventriculair assist device Bridge to Bridge



The TandemHeart as a bridge to a long-term axial-flow loft ventriculair assist device Bridge to Bridge



Texas Heart Institute Journal 35(2): 125-129



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 nonpulsatlle 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 (R), a percutaneously implanted device for short-term cardiac assistance, to lower the risk of death and improve hemodynamic performance and endorgan perfusion before implanting long-term assist devices in selected patients with signs of profound cardiogenic shock.Nine end-stage heart-failure patients (mean age, 377 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.m(2)) (range, 0.0-1.8 L/[min-m(2)]) (0.0 L/[min.m(2)] implies active cardiopulmonary resuscitation), improved to 2.97 L/(min-m(2)) (range, 2.2-4.0 L/ [min.m(2)]) 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.

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Accession: 033708182

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PMID: 18612448


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