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Schwartz BG, Ludeman DJ, Mayeda GS, et al. Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience. Cardiol Res. 2012;3(2):54-66doi: 10.4021/cr121w.
Schwartz, B. G., Ludeman, D. J., Mayeda, G. S., Kloner, R. A., Economides, C., & Burstein, S. (2012). Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience. Cardiology research, 3(2), 54-66. https://doi.org/10.4021/cr121w
Schwartz, Bryan G, et al. "Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience." Cardiology research vol. 3,2 (2012): 54-66. doi: https://doi.org/10.4021/cr121w
Schwartz BG, Ludeman DJ, Mayeda GS, Kloner RA, Economides C, Burstein S. Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience. Cardiol Res. 2012 Apr;3(2):54-66. doi: 10.4021/cr121w. Epub 2012 Mar 20. PMID: 28348673; PMCID: PMC5358142.
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Cardiol Res. 2012 Apr;3(2):54-66. doi: 10.4021/cr121w. Epub 2012 Mar 20.

Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience.

Cardiology research

Bryan G Schwartz, Daniel J Ludeman, Guy S Mayeda, Robert A Kloner, Christina Economides, Steven Burstein

Affiliations

  1. Heart Institute, Good Samaritan Hospital, Los Angeles, California, USA.
  2. Department of Cardiology, Good Samaritan Hospital, Los Angeles, California, USA.
  3. Heart Institute, Good Samaritan Hospital, Los Angeles, California, USA; Department of Internal Medicine, Division of Cardiovascular Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.

PMID: 28348673 PMCID: PMC5358142 DOI: 10.4021/cr121w

Abstract

BACKGROUND: Patients with cardiogenic shock (CS) are routinely treated with intra-aortic balloon pumps (IABPs). The utility of 2 new percutaneous left ventricular assist devices (PLVADs), the Impella and TandemHeart, is unknown. The objective of this study was to describe the use of PLVADs for patients with CS at our institution.

METHODS: All cases involving PLVADs in patients with CS between between January 1, 2008 and June 30, 2010 at a private, tertiary referral hospital were reviewed retrospectively.

RESULTS: All 76 cases were identified (50 IABP only, 7 Impella, 19 TandemHeart). Most Impella (5/7) and TandemHeart (10/19) patients were initially treated with an IABP before "upgrading" for increased hemodynamic support. All 76 devices (100%) were initiated successfully. Percutaneous revascularization was attempted in 63 patients with angiographic success in 57 (90%). The incidences of major complications were similar between groups, except bleeding occurred less frequently with the IABP. Mean ejection fraction on presentation was 30.4±16.5% and increased by a mean of 6.6±11.4% (P < 0.001). With the institutional approach of treating patients with CS initially with vasopressors and IABPs, then upgrading to an Impella or TandemHeart device for patients refractory to IABP therapy, the overall mortality rate was 40%.

CONCLUSION: The Impella and TandemHeart devices can be initiated successfully in patients with CS, are associated with high rates of angiographic success during high risk percutaneous interventions and may benefit the myocardium during myocardial infarction. Randomized trials are warranted investigating use of the Impella and TandemHeart devices in patients with CS and in patients refractory to conventional IABP therapy.

Keywords: Cardiogenic shock; Cardiopulmonary resuscitation; Heart failure; Heart-assist devices; Hemodynamics; Myocardial infarction

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