TandemHeart: A Percutaneous Ventricular Assist Device (pVAD)

Introduction

TandemHeart is a type of percutaneous ventricular assist device (pVAD) used to provide short-term mechanical circulatory support in patients with severe heart failure or cardiogenic shock. It is particularly useful when traditional medical management is insufficient.

How Does TandemHeart Work?

Key Features:

  • Percutaneous insertion: Unlike surgical ventricular assist devices (VADs), TandemHeart can be implanted via catheterization, avoiding open-heart surgery.
  • Left atrial-to-femoral artery bypass: It withdraws oxygenated blood from the left atrium and pumps it into the femoral artery, bypassing the failing ventricle.
  • Improved cardiac output: It can provide a significant increase in cardiac output (up to 5 L/min), stabilizing organ perfusion in critical patients.
  • Short-term use: It is designed for temporary support, typically a few days, until further therapeutic decisions (e.g., heart transplant, durable VAD, or recovery).

Clinical Applications

Indications:

  • Cardiogenic shock due to acute myocardial infarction (AMI)
  • Decompensated heart failure
  • High-risk percutaneous coronary interventions (PCI)
  • Bridge to longer-term mechanical support or transplant

Contraindications:

  • Severe peripheral vascular disease (blocks femoral artery access)
  • Aortic regurgitation (as blood might pump backward)
  • Left atrial thrombus (risk of embolization)

Benefits and Risks

Benefits:

  • Rapid deployment and stabilization
  • Avoids the complexity of surgical VAD implantation
  • Provides better unloading of the left ventricle compared to intra-aortic balloon pumps (IABP)

Risks:

  • Vascular complications (e.g., limb ischemia, bleeding)
  • Hemolysis (destruction of red blood cells)
  • Infection
  • Risk of thromboembolism

Conclusion

TandemHeart is an effective short-term mechanical circulatory support device that offers a bridge to recovery or more long-term solutions in critically ill patients. However, its usage should be carefully considered based on patient suitability and potential complications.

Source recommendations

1. American Heart Association Guidelines for Cardiogenic Shock

  1. https://www.ahajournals.org/doi/10.1161/JAHA.119.011991
  2. https://www.heart.org/en/professional/quality-improvement/cardiogenic-shock-registry
  3. https://www.ahajournals.org/doi/10.1161/cir.0000000000000525
  4. https://www.jacc.org/doi/10.1016/j.jacc.2021.12.012
  5. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001309

2. European Society of Cardiology Guidelines on Acute Heart Failure

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
  2. https://academic.oup.com/eurheartj/article/42/36/3599/6358045
  3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Focused-Update-on-Heart-Failure-Guidelines
  4. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
  5. https://pubmed.ncbi.nlm.nih.gov/34447992/

3. American College of Cardiology Consensus on Mechanical Circulatory Support

  1. https://pubmed.ncbi.nlm.nih.gov/25861963/
  2. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2015/04/07/12/51/2015-expert-consensus-on-percutaneous-mechanical-circulatory-support
  3. https://scai.org/publications/clinical-documents/scaiacchfsasts-clinical-expert-consensus-statement-use-percutaneous
  4. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/03/15/21/55/2022-ACC-Expert-Consensus-on-CV-Sequelae-of-COVID
  5. https://www.jacc.org/doi/10.1016/j.jacc.2015.02.043

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