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Hemodynamic Support with a Percutaneous Left Ventricular Assist Device during Stenting of an Unprotected Left Main Coronary Artery

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  • Case Reports
  • Medicine


kar.qxp Texas Heart Institute Journal Clinical Experience with the TandemHeart® pVAD 111 Clinical Investigation Clinical Experience with the TandemHeart® Percutaneous Ventricular Assist Device The TandemHeart ® percutaneous ventricular assist device can be used to support pa- tients in cardiogenic shock (until cardiac recovery occurs or as a bridge to definitive therapy) or as a temporary application during high-risk coronary interventions. The TandemHeart is a left atrial-to-femoral artery bypass system comprising a trans- septal cannula, arterial cannulae, and a centrifugal blood pump. The pump can deliver flow rates up to 4.0 L/min at a maximum speed of 7500 rpm. From May 2003 through May 2005, the TandemHeart was used to support 18 pa- tients (11 in cardiogenic shock and 7 undergoing high-risk percutaneous transluminal coronary angioplasty). The patients in cardiogenic shock were supported for a mean of 88.8 ± 74.3 hours (range, 4–264 hr) at a mean pump flow rate of 2.87 ± 0.56 L/min (range, 1.8–3.5 L/min). The mean cardiac index improved from 1.57 ± 0.31 L/min/m2 be- fore support to 2.60 ± 0.34 L/min/m2 during support. The mean duration of support for the high-risk percutaneous transluminal coronary angioplasty patients was 5.5 ± 8.3 hours (range, 1–24 hr). The mean flow rate was 2.42 ± 0.55 L/min (range, 1.5–3.0 L/ min). The overall 30-day survival rate was 61%. In our experience, the TandemHeart device was easy to insert and provided a means either to cardiac recovery or to continued support with an implantable left ventricular assist device. (Tex Heart Inst J 2006;33:111-5) mplantable mechanical circulatory support (MCS) systems have evolved over the past 25 years and are now in widespread use. The most frequently used of the MCS systems are fully implantable or require direct cannulation of the heart. Because cardiac surgery with the aid of cardiopulmonary bypass (CPB) is usually required for the implantation of most of these devices, their use may be limited in

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