Division of Cardiology, Northwestern University, Feinberg School of Medicine, Bluhm Cardiovascular Institute at Northwestern Memorial Hospital, Chicago, Illinois, USA.
ASAIO J. 2011 Jul-Aug;57(4):254-61. doi: 10.1097/MAT.0b013e318218679e.
There is a paucity of literature describing the outcomes associated with the use of TandemHeart percutaneous ventricular assist device (PVAD). The literature is limited by analyzing only subsets of patients. We present the clinical outcomes and safety associated with the use of TandemHeart among a series of heterogeneous patients requiring PVAD support. We reviewed the clinical experience, hemodynamic variables, survival outcomes, and complications associated with the implantation of TandemHeart support device among 25 patients presenting to our institution. Indications for PVAD implantation were cardiogenic shock (56%), ST-segment elevation myocardial infarction (STEMI) (20%), postpericardiotomy (16%), and high-risk percutaneous coronary interventions (PCI) or ventricular tachycardia (VT) ablation (8%). TandemHeart was used for an average of 4.8 ± 2.1 days and demonstrated significant hemodynamic improvements (pre- and postimplantation left ventricular ejection fractions were 21.5% ± 15% and 24.5% ± 10.5%, respectively [p = 0.06]). The cardiac index improved from a mean 2.04 ± 075 L/min/m² to 2.45 ± 073 L/min/m² (p = 0.09). The mixed venous oxygen saturation (SVO2) increased from 55.14 ± 13.34 to 66.43 ± 7.43 (p = 0.008) after implantation. TandemHeart was used as a bridge to left ventricular assist device implantation (44%) or recovery (20%). Thirty-six percent of patients died on support or shortly after PVAD removal. Thirty, 90-day, and long-term (>90 days) survival rates were 56%, 52%, and 36%, respectively. Procedure-related complications were reported in 13 patients (56%), and the majority (90%) was related to vascular access (bleeding or pseudoaneurysm). The TandemHeart device is a safe therapeutic option as a bridge-to-recovery or bridge-to-bridge for patients with hemodynamic compromise regardless of the etiology. The favorable hemodynamic profile, postimplantation survival rates, and manageable complications support its use to assist hemodynamic recovery in patients refractory to conventional therapy.
关于使用 TandemHeart 经皮心室辅助装置（PVAD）相关结果的文献非常少。由于文献仅分析了患者的部分亚组，因此受到了限制。我们介绍了一系列需要 PVAD 支持的异质性患者使用 TandemHeart 的临床结果和安全性。我们回顾了 25 例患者在我院植入 TandemHeart 支持装置的临床经验、血流动力学参数、生存结果和并发症。PVAD 植入的指征为心源性休克（56%）、ST 段抬高型心肌梗死（STEMI）（20%）、心包切开术后（16%）和高危经皮冠状动脉介入治疗（PCI）或室性心动过速（VT）消融（8%）。TandemHeart 的使用平均为 4.8±2.1 天，并显示出显著的血流动力学改善（植入前后左心室射血分数分别为 21.5%±15%和 24.5%±10.5%，p=0.06）。心指数从平均 2.04±0.75L/min/m²增加到 2.45±0.73L/min/m²（p=0.09）。混合静脉血氧饱和度（SVO2）从植入前的 55.14±13.34增加到植入后的 66.43±7.43（p=0.008）。TandemHeart 被用作左心室辅助装置植入（44%）或恢复（20%）的桥接。36%的患者在支持或 PVAD 移除后不久死亡。30 天、90 天和长期（>90 天）生存率分别为 56%、52%和 36%。报告了 13 例（56%）与操作相关的并发症，其中大多数（90%）与血管通路有关（出血或假性动脉瘤）。无论病因如何，TandemHeart 装置作为血流动力学受损患者的桥接恢复或桥接桥接治疗的安全治疗选择。有利的血流动力学特征、植入后的生存率和可管理的并发症支持其用于帮助对常规治疗无反应的患者恢复血流动力学。
