Key result
TandemHeart upgrade restores cardiac function in 3 cases of Impella-refractory cardiogenic shock.
Why the study?
Data and clinical trials demonstrating the efficacy of TandemHeart over other mechanical circulatory support devices remain scarce.
Case Report (n=3)
No
The TandemHeart system may serve as an effective mechanical circulatory support option for patients with severe cardiogenic shock who are refractory to Impella.
May support TandemHeart rescue in select Impella-refractory shock; leaves open need for prospective trials.
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.
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Shah et al. (2023) conducted a case report in Severe Cardiogenic Shock and Acute Decompensated Heart Failure (n=3). TandemHeart vs. Impella (prior failed therapy) was evaluated on Recovery of ejection fraction and survival to discharge. In three cases of severe cardiogenic shock refractory to Impella, upgrading to the TandemHeart system resulted in steady recovery of cardiac function and successful weaning off inotropic support.
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