Abstract 2364: Use of the Tandem Heart™ for Left Ventricular Support in Patients with Refractory Cardiogenic Shock
OBJECTIVE: Cardiogenic shock is still associated with very high in-hospital mortality, despite the aggressive use of the intra-aortic balloon pump (IABP). New mechanical support devices have become available in recent years, including the Tandem Heart™, a low-speed continuous-flow percutaneously placed left ventricular assist device. We sought to determine the efficacy of the Tandem Heart™ in both ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM) patients who remained in cardiogenic shock despite the aggressive use of IABP and pressor support.
RESULTS: From May 2003 to April 2006 Tandem Heart™ devices were placed in 36 patients in severe, refractory cardiogenic shock. The average age was 57.8 ± 15.4 years; 24 were males and 12 were females. There were 15 patients with NICM and 21 patients with ICM. Thirty-two patients were already on IABP support with persistent hypotension. The average number of pressors used was 2.4 ± 1.2. The average duration of Tandem Heart™ support was 3.7 ± 2.9 days. Twelve of the patients underwent high-risk percutaneous/surgical revascularization, 12 went on to LVAD placement and one received an orthotopic heart transplant. Survival at 30 days and 6 months were 56% and 44%, respectively. Complications included one left atrial perforation (fatal) and one patient with arterial injury requiring repair.
CONCLUSION: The Tandem Heart™ device provides substantial hemodynamic support in severe, refractory cardiogenic shock patients who remain unstable despite aggressive use of IABP and pressor support. In-hospital mortality in this extremely high-risk group was 44% at 30 days.