The TandemHeart®, percutaneous transseptal left ventricular assist device: a safeguard in high-risk percutaneous coronary interventions. The six-year Rotterdam experience

AIMS: Percutaneous coronary interventions (PCI) in high-risk cardiac patients are preferentially referred to specialised myocardial intervention centres (MIC). Included in this group are patients with a haemodynamic collapse or high likelihood of haemodynamic collapse, either during balloon inflation or with acute vessel closure. The TandemHeart, a percutaneous transseptal left ventricular assist (PTVA) that can be introduced using standard catheterisation laboratory techniques, offers interesting perspectives to reduce procedural risks. METHODS AND RESULTS: Between September 2000 to July 2006, The TandemHeart, supported the circulation of 23 patients (age: range 46-74, mean 59) admitted to our centre for high risk, either emergency or elective, PCI. Successful implantation was achieved in 100% of patients. The mean time for implementation of circulatory support was 35 minutes (range 16-62). The index PCI was successful in all patients except two. A pump flow up to 4L/min was achieved with significant reduction of left ventricular filling pressures, pulmonary capillary wedge pressure and with significant increase of systemic arterial pressures. Duration of support ranged from 1-222 hours (mean 31+/-49.8 hours). Five patients died with the TandemHeart in place, four of whom were in irreversible cardiogenic shock at admission. Mild to moderate access site bleeding was seen in 27% of patients. One patient experienced a loge syndrome of the leg. Core temperature (Ct) decreased to <36.5 degrees C in six patients, profound hypothermia (Ct <35 degrees C) was observed in two patients. There was no technical device failure. CONCLUSIONS: The TandemHeart - PTVA provides effective, total left ventricular support in very high risk PCI settings. The rate of device related cardiac and vascular complications was acceptable.