Original title: Percutaneous Left Ventricular Assist Device with Tandem Heart for High-Risk Percutaneous Coronary Intervention: The Mayo Clinic Experience. Reference: Oluseun O Alli, et al. Catheterization and Cardiovascular Intervention 80:728:734
There is a small group of poor surgical patients admitted for surgery that due to complex comorbidity, coronary anatomy and compromised left ventricular function that can be treated with coronary angioplasty (PCI) as an alternative.
The goal of this study was to analyze the feasibility of Tandem Heart Cardiac Assist (Cardiac Assist, Pittsburgh, PA) ventricular assist devices in high risk patients. This is a retrospective analysis from a site that included 54 patients undergoing PCI with ventricular assistance.
High risk criteria were: <30% median ejection fraction, a threatening >8 cardiac score, vessel occlusion and the presence of comorbidities contraindicating cardiac surgery.
Two operators performed the procedures. The most relevant of baseline features were: average age 72, median ejection fraction 20%, diabetics 41%, previous revascularization surgery 50%, previous MI 52%, and counterpulsation balloon 45%.
30% presented cardiogenic shock, solved at procedure. Coronary anatomy was complex reaching a median Syntax score of 33. PCI was performed to the main left and multiple vessels in 62% and a total of 48% required rotablation.
The procedure had a 97% success rate. The use of ventricular assistance significantly improved L/min rates, mean auricular pressure, pulmonary pressure and Wedge pressure. Improvement was sustained after device removal. Survival rate at 30 days was 90%, and 87% at six months.
Conclusion
Ventricular assistance is feasible as therapeutic strategy in patients with complex coronary disease, compromised ventricular function and high surgical risk..
Editorial Comment:
This study shows that high risk patients that make bad surgical candidates can be treated, but the adequate tools to achieve successful outcomes still need further development. The study is retrospective, it involved only one site, very few patients and only two operators; these factors constitute limitations that weaken external validation but serve as support for further extensive research.
Courtesy of Dr. Carlos Fava
Interventional Cardiologist
Favaloro Foundation – Argentina
Dr. Carlos Fava para SOLACI.ORG