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

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.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.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.