Tandem Heart Research Articles

Laparoscopic Cholecystectomy in Cardiogenic Shock And Heart Failure.

Background: Patients with cardiogenic shock (CS) or heart failure can develop ischemic cholecystitis from a systemic low-flow state. Cholecystectomy in high-risk patients is controversial. Percutaneous cholecystostomy tube (PCT) is often the chosen intervention; however, data on PCT as definitive treatment are conflicting. Data on cholecystectomy in these patients are limited. This study discusses outcomes following laparoscopic cholecystectomy (LC) in this patient population. Methods: This is a retrospective review of patients who underwent LC from 2015 to 2019 while hospitalized for CS or heart failure. Surgical services are provided by fellowship-trained minimally invasive surgeons at a single, academic, tertiary-care center. Patient characteristics are reported as frequencies' percentages for categorical variables. Odds ratio is used to determine the association between comorbidities and complications. Results: Twenty-four patients underwent LC. Around 83% were white and 79% were male. Many were anticoagulated (88%), with Class IV heart failure (63%), and required vasopressors (46%) at the time of surgery. Fourteen of 24 (58%) had at least one circulatory device at the time of surgery: extracorporeal membrane oxygenation, left ventricular assist device, Impella, tandem heart, and total artificial heart. Four patients (17%) had PCT preoperatively. Fifteen days were the average interval between diagnosis and surgery. Pneumoperitoneum was tolerated by all, and 0% converted to open. Most common complication was bleeding (52%). Nine patients (37.5%) underwent 21 reoperations, one of which (4%) was related to cholecystectomy. Mortality occurred in 5 patients (20.8%); interval between cholecystectomy and mortality ranged 6-30 days. Conclusion: Although high risk, LC is a treatment option in patients with ischemic cholecystitis at risk for death from sepsis.

Bridge to Life: Current Landscape of Temporary Mechanical Circulatory Support in Heart-Failure-Related Cardiogenic Shock.

Acute heart failure (HF) presents a significant mortality burden, necessitating continuous therapeutic advancements. Temporary mechanical circulatory support (MCS) is crucial in managing cardiogenic shock (CS) secondary to acute HF, serving as a bridge to recovery or durable support. Currently, MCS options include the Intra-Aortic Balloon Pump (IABP), TandemHeart (TH), Impella, and Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO), each offering unique benefits and risks tailored to patient-specific factors and clinical scenarios. This review examines the clinical implications of recent advancements in temporary MCS, identifies knowledge gaps, and explores promising avenues for future research and clinical application. Understanding each device's unique attributes is crucial for their efficient implementation in various clinical scenarios, ultimately advancing towards intelligent, personalized support strategies.

Mechanical Circulatory Support Strategies in Takotsubo Syndrome with Cardiogenic Shock: A Systematic Review.

Takotsubo syndrome is, by definition, a reversible form of acute heart failure. If cardiac output is severely reduced, Takotsubo syndrome can cause cardiogenic shock, and mechanical circulatory support can serve as a bridge to recovery. To date, there are no recommendations on when to use mechanical circulatory support and on which device is particularly effective in this context. Our aim was to determine the best treatment strategy. A systematic literature research and analysis of individual patient data was performed in MEDLINE/PubMed according to PRISMA guidelines. Our research considered original works published until 31 July 2023. A total of 93 publications that met the inclusion criteria were identified, providing individual data from 124 patients. Of these, 62 (50%) were treated with veno-arterial extracorporeal life support (va-ECLS), and 44 (35.5%) received a microaxial left ventricular assist device (Impella). Eighteen patients received an Impella CP and twenty-one an Impella 2.5. An intra-aortic balloon pump (IABP) without other devices was used in only 13 patients (10.5%), while other devices (BiVAD or Tandem Heart) were used in 5 patients (4%). The median initial left ventricular ejection fraction was 20%, with no difference between the four device groups except for the IABP group, which was less affected by cardiac output failure (p = 0.015). The overall survival was 86.3%. Compared to the other groups, the time to cardiac recovery was shorter with Impella (p < 0.001). Though the Impella treatment is new, our analysis may show a significant benefit of Impella compared to other MCS strategies for cardiogenic shock in Takotsubo syndrome.

P6: Mechanical Circulatory Support for Acute Severe Aortic Regurgitation and Cardiogenic Shock

Background: We describe a case of cardiogenic and septic shock complicated by acute severe aortic regurgitation (AR) temporized by left-atrial-venoarterial (LA-VA) ECMO. Patient Presentation & Results: A 42-year-old female with end stage renal disease, type 2 diabetes, and osteomyelitis of the right foot on outpatient intravenous antibiotics presented with fevers. On initial evaluation, transthoracic echocardiogram (TTE) demonstrated normal left ventricular (LV) function with no valvular abnormalities and methicillin resistant staphylococcus aureus was identified in blood cultures. Despite several days of antibiotic treatment, the patient decompensated requiring intubation and vasopressors. Vitals were notable for a blood pressure of 80/10 mmHg. A repeat TTE demonstrated severe AR with leaflet perforation consistent with endocarditis. The patient suffered cardiac arrest and after return of spontaneous circulation, she was taken to the catheterization laboratory for mechanical circulatory support. Via the right femoral vein, initial transeptal puncture revealed a LA pressure of 35mmHg with V waves to 45mmHg. A 21Fr transeptal drainage cannula was placed in the LA with a 17Fr return cannula in the left common femoral artery for extracorporeal support with a Tandem Heart (Livanova) system. Right heart catheterization on 5Lpm of support along with epinephrine, levophed, dopamine and vasopressin were as follows: RA 13mmHg, PA 50/22 mmHg (mean 35mmHg, PA sat 53.5%) and CO/CI of 4.49/2.27 L/min/m2. Overnight the transeptal cannula was dislodged and an oxygenator was rapidly spliced converting the system to VA ECMO. On this configuration she underwent bedside guillotine amputation of the right foot and was then taken back to the catheterization laboratory where a second drainage cannula was placed into the LA, this time from the left femoral vein. A Y-connector was used to allow simultaneous inflow from both the displaced right atrial cannula (which was partially pulled into the IVC) and the new LA cannula into the pump (Picture 1). The patient underwent successful surgical aortic valve replacement (SAVR) with a 23mm Edwards Inspirus bioprosthesis. She was successfully weaned off circulatory support and ultimately discharged. Conclusion: Severe AR has been known to be a major contraindication for VA ECMO. In addition to hemodynamic instability and rapidly rising LA pressures with subsequent pulmonary edema, a noncompetent aortic valve makes MCS a unique challenge in cases of acute severe AR. In our case, normal LV function and unloading of the LA allowed for appropriate native LV output despite increased afterload from femoral artery return in the setting of severe AR. LA-VA ECMO created a window of hemodynamic stability to allow for amputation of an infected foot and successful SAVR.

Cardiogenic shock - novelty and emerging therapeutic concepts

The cardiogenic shock is a state of low cardiac output, primarily due to cardiac dysfunction, which leads to severe organ hypoperfusion with tissue hypoxia and increased lactate levels. It presents a severe complication with a prevalence of around 15% of all forms of shock and 2-5% of the cardiogenic shock is a complications of acute heart failure. Despite the diverse etiology of the cardiogenic shock, up to 80% of the cases are due to acute myocardial infarction. The ischemia, leads to dysfunction of the myocardium cells, which causes a decline in the blood pressure and subsequent tissue hypoperfusion. The most important part is to start the treatment regime as soon as possible in the pre-shock stage. The treatment of refractory cardiogenic shock is complex, as it contains an intravenous therapy with inotropes/vasopressors and mechanical circulatory support (MCS). The MCS devices are supposed to reduce the workload of the heart and the oxygen need of the myocardial cells and in the same time to maintain an adequate coronary and systemic perfusion. There are different MCS devices like IABP, Impella, Tandem Heart, V-A ECMO. The aim of this review article is to present the new trends in the treatment approach to cardiogenic shock and to bring clarity in the treatment regimes, based on the latest studies and guidelines.

Mechanical Circulatory Support in Delayed Surgery of Post-Infarction Ventricular Septal Rupture in Patients in Cardiogenic Shock—A Review

Post-infarction ventricular septal rupture (VSR) is a serious complication of myocardial infarction, which, in its natural course or treated medically, is related to high mortality rate. Surgical intervention remains the treatment of choice. Recent studies have shown that delayed surgery is related to better outcomes in comparison with urgent surgery; however, in many studies the impact of the patients’ initial hemodynamic status on the treatment outcomes often remains unclear. In this review, we analyze the outcomes of delayed surgical treatment of patients in cardiogenic shock in the course of post-infarction ventricular septal defect stabilized with preoperative use of mechanical circulatory support. We evaluate the importance of various types of mechanical circulatory devices (MCD), such as extracorporeal membrane oxygenation, Tandem Heart, Impella, and intra-aortic baloon pump (IABP) in preoperative stabilization of patients, and the most suitable time for surgery, and we also present the features of ideal MCD for patients with VSR. A search of Pubmed to identify studies concerning the use of MCD in patients in cardiogenic shock in the course of VSR qualified for delayed surgery was conducted in January 2022. A total of 16 articles with three or more patients described were analyzed in this study. The preoperative use of MCD in patients in cardiogenic shock and delayed surgery as a main part of treatment seems to be a promising direction, however, it requires further research.

Gender Differences in the Outcomes of Cardiogenic Shock Requiring Percutaneous Mechanical Circulatory Support

There is evidence for the lower use of percutaneous mechanical circulatory support (pMCS) in women. We aimed to determine (1) whether gender differences exist regarding in-hospital mortality, hospital course, and procedures; (2) whether socio-demographic and treatment-related factors were associated with these differences. Using the National Inpatient Sample, we collected the International Classification of Diseases, Ninth Revision, Clinical Modification codes for cardiogenic shock (CS) because of acute myocardial infarction AMI or acutely decompensated advanced heart failure and included intra-aortic balloon pump, Impella or Tandem Heart percutaneous ventricular assist devices (pVADs), extracorporeal membrane oxygenation. Demographics, co-morbidities, in-hospital course and procedures were recorded, and the Charlson Co-morbidity Index was calculated. Multivariable hierarchical logistic regression analysis and additional sensitivity analyses were performed. We identified 376,116 cases of CS because of acute myocardial infarction or acutely decompensated advanced heart failure, of which 113,305 required pMCS. Women were more likely to be older, non-White, insured by Medicare, and have a higher burden of co-morbidities and higher Charlson Co-morbidity Index. pMCS devices were inserted in 35,516 women (24.9%) and 77,789 men (33.3%). Women were less likely to receive pVAD or pulmonary artery (PA) catheters. Blood transfusions and acute respiratory failure were more common in women than men. Women had 15% higher in-hospital mortality and in a multivariate analysis, women, older age, having no insurance, diabetes mellitus, chronic kidney disease, cerebrovascular disease, peripheral arterial disease, longer time to pMCS insertion, receiving PA catheter, pVAD or extracorporeal membrane oxygenation and having cardiac arrest were associated with higher in-hospital mortality. In conclusion, women requiring pMCS support had a higher co-morbidity load, in-hospital mortality, acute respiratory failure, blood transfusions, and lower PA catheter use. Studies addressing early gender-specific interventions in CS are needed to reduce these differences.

Pulse Contour Analysis: A Useful Tool for Decision Making During Temporary Mechanical Circulatory Support

<h3>Introduction</h3> As time on temporary mechanical circulatory support (TMCS) increases, so does risk of device-related complications. Decisions to wean TMCS are largely based on echocardiographic (echo) and pulmonary artery catheter data. We describe the use of pulse contour analysis (PCA) for real-time decision making during TMCS. <h3>Case Report</h3> A 58-year-old male with CAD and recent anterior STEMI with PCI to LAD presented with cardiogenic shock. LV apical thrombus was noted in echo. He developed pulmonary edema and respiratory failure requiring mechanical ventilation. Invasive hemodynamics were notable for: RA 25mmHg, PCWP 45mmHg, CO 3.45 L/min, CI 1.5 L/min/m2. An IABP was placed but his condition rapidly deteriorated despite escalating inotropes, culminating in VF arrest. Left atrial to femoral artery support with Tandem Heart (TH) was started. On day 10, he developed hemoptysis and rectal bleeding. A decision was made to wean TMCS to stop anticoagulation given ongoing bleeding. Initial TH flow was 3.5-3.7 L/min at a speed of 6900 RPM (Fig 1A). Systemic flow by PCA was 2.9-3L which correlated with CO by thermodilution at ∼3 L/min (6.85L/min - 3.5 L/min)(Fig 1B and 1C). At a TH flow of 2 L/min, CO estimate by PCA was available for bedside analysis and remained low at 4.0 l/min (CI 1.8/min/m2) despite no change in cardiac chamber size or filling pressures. Echo data and filling pressures did not reflect his poor native blood flow as TMCS was weaned and further weaning could have caused progressive shock. Based on the persistently low CO estimates noted by PCA, a decision was made to continue MCS until he underwent durable LVAD implant. <h3>Summary</h3> PCA estimates SV based on the contour of the arterial pressure tracing, and when coupled with HR approximates systemic flow. PCA is most accurate in the absence of arrhythmia or respiratory variability. Data is continuously updated in real time compared to conventional measures of CO. To our knowledge this is the first report of the use of PCA to aid real time decision making during TMCS.

Mortality in cardiogenic shock patients receiving mechanical circulatory support: a network meta-analysis

ObjectiveMechanical circulatory support (MCS) devices are widely used for cardiogenic shock (CS). This network meta-analysis aims to evaluate which MCS strategy offers advantages.MethodsA systemic search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials was performed. Studies included double-blind, randomized controlled, and observational trials, with 30-day follow-ups. Paired independent researchers conducted the screening, data extraction, quality assessment, and consistency and heterogeneity assessment.ResultsWe included 39 studies (1 report). No significant difference in 30-day mortality was noted between venoarterial extracorporeal membrane oxygenation (VA-ECMO) and VA-ECMO plus Impella, Impella, and medical therapy. According to the surface under the cumulative ranking curve, the optimal ranking of the interventions was surgical venting plus VA-ECMO, medical therapy, VA-ECMO plus Impella, intra-aortic balloon pump (IABP), Impella, Tandem Heart, VA-ECMO, and Impella plus IABP. Regarding in-hospital mortality and 30-day mortality, the forest plot showed low heterogeneity. The results of the node-splitting approach showed that direct and indirect comparisons had a relatively high consistency.ConclusionsIABP more effectively reduce the incidence of 30-day mortality compared with VA-ECMO and Impella for the treatment of CS.

A Case of Inf A Case of Inferior My erior Myocardial Infar dial Infarction Complicated b ction Complicated by Ventricular Septal Ruptur entricular Septal Rupture Leading t e Leading to Cardiogenic Shock: T diogenic Shock: Tandem Heart to the Rescue!

Ventricular septal rupture (VSR) is a rare but life-threatening complication of acute myocardial infarction. We present a case of VSR-related refractory cardiogenic shock that was successfully managed with TandemHeart® followed by surgical repair.

Abstract 11451: Use of Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights from the PROGRESS-CTO Registry

Introduction: The use of mechanical circulatory support (MCS) in complex percutaneous coronary intervention (PCI) is the subject of ongoing investigation, but the role of MCS in chronic total occlusion (CTO) PCI is not well studied. Methods: We analyzed the patient and angiographic characteristics and procedural outcomes of 7,171 CTO PCIs performed between 2012 and June 2021 at 35 international centers. Results: Mean patient age was 64.5±10 years, mean left ventricular ejection fraction was 50 ± 13 % and 82% were men. MCS was used in 4.5% of the overall cases, MCS use was elective in 78.7% and urgent in 21.3%. The most common type of MCS was Impella CP (55.5%) followed by intra-aortic balloon pump (14.8%), Tandem Heart (10.0%) and Impella 2.5 (8.7%). Diabetes mellitus (51.0% vs. 42.4%, p=0.003), prior congestive heart failure (60.6% vs. 27.9%, p&lt;0.001) and prior myocardial infarction (52.3% vs. 45.3%, p=0.020) were more common in MCS patients. Left ventricular ejection fraction was lower in the patients with MCS use compared to patients without (Mean±standard deviation, 51.0 ± 12 vs. 34.0 ± 15 %, p&lt;0.001). Cases in which MCS was used were more complex with higher J-CTO score compared with cases without MCS (2.94 ± 1.19 vs. 2.39 ± 1.27, p&lt;0.001). Cases performed with MCS had lower technical (81.6% vs. 86.7%, p=0.011) and procedural (71.3% vs. 85.6%, p&lt;0.001) success rates with higher rates of periprocedural major cardiac adverse events compared to no MCS use (12.6% vs. 1.68%, p&lt;0.001). Conclusions: In a contemporary, multicenter registry MCS was used in 4.5% of CTO PCI. Cases where MCS was used were associated with lower technical and procedural success with higher periprocedural major complication rates. Further investigation is required to see if elective use of MCS can improve outcomes in patients with increased comorbidities and higher lesion complexity.

Syndrome of Reversible Cardiogenic Shock and Left Ventricular Ballooning in Obstructive Hypertrophic Cardiomyopathy.

BackgroundCardiogenic shock from most causes has unfavorable prognosis. Hypertrophic cardiomyopathy (HCM) can uncommonly present with apical ballooning and shock in association with sudden development of severe and unrelenting left ventricular (LV) outflow obstruction. Typical HCM phenotypic features of mild septal thickening, outflow gradients, and distinctive mitral abnormalities differentiate these patients from others with Takotsubo syndrome, who have normal mitral valves and no outflow obstruction.Methods and ResultsWe analyzed 8 patients from our 4 HCM centers with obstructive HCM and abrupt presentation of cardiogenic shock with LV ballooning, and 6 cases reported in literature. Of 14 patients, 10 (71%) were women, aged 66±9 years, presenting with acute symptoms: LV ballooning; depressed ejection fraction (25±5%); refractory systemic hypotension; marked LV outflow tract obstruction (peak gradient, 94±28 mm Hg); and elevated troponin, but absence of atherosclerotic coronary disease. Shock was managed with intravenous administration of phenylephrine (n=6), norepinephrine (n=6), β‐blocker (n=7), and vasopressin (n=1). Mechanical circulatory support was required in 8, including intra‐aortic balloon pump (n=4), venoarterial extracorporeal membrane oxygenation (n=3), and Impella and Tandem Heart in 1 each. In refractory shock, urgent relief of obstruction by myectomy was performed in 5, and alcohol ablation in 1. All patients survived their critical illness, with full recovery of systolic function.ConclusionsWhen cardiogenic shock and LV ballooning occur in obstructive HCM, they are marked by distinctive anatomic and physiologic features. Relief of obstruction with targeted pharmacotherapy, mechanical circulatory support, and myectomy, when necessary for refractory shock, may lead to survival and normalization of systolic function.

Erratum to 'Previously Undiagnosed Patent Foramen Ovale as Cause of Hypotension and Hypoxemia in a Patient With Recent Tandem Heart LVAD Insertion' [Journal of Cardiothoracic and Vascular Anesthesia 34 (2020) 3170-3172

Erratum to 'Previously Undiagnosed Patent Foramen Ovale as Cause of Hypotension and Hypoxemia in a Patient With Recent Tandem Heart LVAD Insertion' [Journal of Cardiothoracic and Vascular Anesthesia 34 (2020) 3170-3172

Incidence, Characteristics and Outcomes of Cardiac Tamponade in Patients on Extracorporeal Membrane Oxygenation for the Treatment of Refractory Cardiogenic Shock

Background Extracorporeal membrane oxygenation(ECMO) for the treatment of refractory cardiogenic shock has gained popularity over the last decade. Cardiac tamponade(CT), a life threatening condition, has been reported to occur in patients after the initiation of ECMO therapy. However, there is a scarcity of data pertaining to the incidence, characteristics and outcomes of pericardial tamponade in non-cardiac surgery patients undergoing ECMO for the treatment of refractory cardiogenic shock. Methodology This is a single center retrospective review of all patients developing CT post ECMO for refractory cardiogenic shock presenting between January 1999-January 2020. Patients were excluded if they were on ECMO post cardiac surgery, aged less than 18 years or had a moderate to large pericardial effusion prior to ECMO initiation. Results Out of 220 patients presenting with cardiogenic shock, 8(3.6%) patients developed CT after being treated with ECMO. Patients were mostly male (7,78%) and 66±12.8 years old. 7(77.5%) patients were on VA ECMO, 1(12.5%) patient on VAV ECMO, all of which were accessed peripherally . 5(62.5%) patients were on additional mechanical support devices: Impella(2,25%), IABP(2,25%) and tandem heart with impella(1,12.5%). 6(75%) patients were supratherapeutic whilst on systemic anticoagulation preceding CT. Initial ECMO pump flow rates were 4±0.68ml/min, mean sheath size of 22±3.1 F. 5(62.5%) patients developed CT 24 hours after ECMO initiation, 3(37.5%) patients before 24 hours. Average size of pericardial effusion was 2.1±0.1cm. None of the patients had any evidence of myocardial/great vessel perforation. 4(50%) patients were treated with pericardiocentesis, 2(25%) patients required pericardial window, and 2(25%) required both. Fluid analysis in 6(87.5%) patients revealed hemorrhagic pericardial fluid, 1(12.5%) with serosanguinous fluid and 1(12.5%) with serous fluid .6(75%) of patients died during hospitalization, but not directly from CT. Conclusion 3.6% of patients on ECMO for refractory cardiogenic shock develop CT, with most cases occurring after 24 hours of therapy initiation. Most patients who develop this are coagulopathic and are on additional mechanical support devices. CT can occur in patients without evidence of cardiac/great vessel perforation. CT should be considered in all patients on ECMO with unexplained reductions in flow rates, and this should immediately be addressed to optimize cardio-pulmonary support. Although treatable, CT in this subset of patients is reflective of an overall grave prognosis.

Incidence and clinical outcomes of bleeding complications and acute limb ischemia in STEMI and cardiogenic shock.

Bleeding complications and acute limb ischemia (ALI) are devastating vascular complications in patients with ST-segment elevation myocardial infarction (STEMI). Cardiogenic shock (CS) can further increase this risk due to multiorgan failure. In the contemporary era, percutaneous mechanical circulatory support is commonly used for management of CS. We hypothesized that vascular complications may be an important determinant of clinical outcomes for CS due to STEMI (CS-STEMI). We evaluated 10-year national trends, resource utilization and outcomes of bleeding complications, and ALI in CS-STEMI. We performed a retrospective cohort study of CS-STEMI patients from a large U.S. national database (National Inpatient Sample) between 2005 and 2014. Events were then divided into four different groups: no MCS, with intra-aortic balloon pump, percutaneous ventricular assist device includes Impella or Tandem Heart or extracorporeal membrane oxygenation. Bleeding complications and ALI were observed in 31,389 (18.2%) and 1,628 (0.9%) out of 172,491 admissions with CS-STEMI, respectively. Between 2005 and 2014, overall trends increased for ALI; however, the number of bleeding events decreased. ALI was associated with increased in-hospital mortality in comparison to those without any ALI. However, bleeding complications were not associated with increased in-hospital mortality. Compared to patients without complications, both bleeding and ALI were associated with increased length of stay (LOS) and hospitalization costs. Bleeding and ALI are common complications associated with CS-STEMI in the contemporary era. Both complications are associated with increased hospital costs and LOS. These findings highlight the need to develop algorithms focused on vascular safety in CS-STEMI.

Abstract 365: Percutaneous Ventricular Assist Devices Versus Intra Aortic Balloon Pump in Cardiogenic Shock

Introduction: Cardiogenic shock (CS) is a condition of insufficient tissue perfusion due to cardiac dysfunction. Despite the improvement in prognosis due to aggressive reperfusion strategies, in-hospital mortality from CS is around 50%. Intra-aortic balloon pump (IABP) has been used for the management of CS. Percutaneous Ventricular Assist Devices (pVAD) such as the tandem heart and the Impella have been developed to treat CS. We carry out a meta-analysis comparing the IABP versus pVAD during CS. Method: Using PubMed, Cochrane Library, and EMBASE we searched for randomized clinical trials (RCTs) that compared pVAD versus IABP in patients CS. Result: We demonstrated no difference in short-term 30 days all-cause mortality (risk ratio [RR] 1.14 [CI: 0.70+/- 1.86]. The RR of acute kidney injury (AKI) for pVAD compared to IABP is 0.96 [CI: 0.46 +/- 2.00], for limb ischemia RR is 3.31 [CI: 1.04 +/- 10.51], for infection/sepsis 0.59 [CI: 0.19+/-1.80], for bleeding 2.41 [CI: 1.41+/- 4.13] and for vascular injury 3.75 [CI: 0.19 +/- 72.49]. Although pVAD provides superior hemodynamic support in patients with CS compared with IABP, the use of these more powerful devices did not improve early survival. The use of pVAD is associated with more adverse events compared with IABP. Discussion: The use of more vigorous hemodynamic support for CS does not associate with a 30 days survival benefit but could be associated with more adverse events. The reason for these findings is unclear but could be explained by the fact that decreased cardiac output seen in CS is only a single component of the multifaceted syndrome that involves several other molecular and hemodynamic mechanisms or merely because of the increase in the cardiac output by the IABP or the pVAD is inadequate to improve outcomes. Conclusion: Use of pVAD resulted in a better hemodynamic profile compared with IABP. However, this did not translate into improved 30-day survival. Also, patients treated with a pVAD have a higher risk of leg ischemia, AKI and, device-related bleeding.

TCT-21 Incidence and Clinical Outcomes of Stroke in Patients With Percutaneous Mechanical Circulatory Support Devices: Insights From a Large National Database

Percutaneous mechanical circulatory support (pMCS), such as intra-aortic balloon pump (IABP), percutaneous ventricular assist device (PVAD) (Impella or Tandem Heart), or extracorporeal membrane oxygenation (ECMO), have emerged as an important tool in recent years for stabilizing patients with ST-

TCT-224 High-Risk Chronic Total Occlusion Percutaneous Coronary Interventions Assisted With Tandem Heart

TCT-224 High-Risk Chronic Total Occlusion Percutaneous Coronary Interventions Assisted With Tandem Heart

Successful Treatment of Refractory Status Asthmaticus Accompanied by Right Ventricular Dysfunction Using a Protek Duo Tandem Heart Device

Successful Treatment of Refractory Status Asthmaticus Accompanied by Right Ventricular Dysfunction Using a Protek Duo Tandem Heart Device

Utilization of Combined Mechanical Circulatory Support Devices in Cardiogenic Shock: Insights from the National Inpatient Sample

Purpose Percutaneous mechanical circulatory support (MCS) devices are used in patients with cardiogenic shock (CS). In cases of incessant ventricular arrhythmias or biventricular failure these devices are used in combination. We studied the trend and mortality outcome of single vs combined MCS devices in patients with CS from the National Inpatient Sample (NIS). Methods We queried the NIS database from 2010 to 2015 for patients admitted with CS, and divided them in ischemic (ICM) and non-ischemic etiology (NICM). Implantation of MCS [Intra-aortic Balloon Pump (IABP), Extracorporeal membrane oxygenation (ECMO), Impella or Tandem Heart pVAD] were identified using appropriate ICD-9 codes. Each cohort was divided into 2 subgroups: single device (IABP or pVAD or ECMO) vs combined (or sequential) MCS (IABP+ECMO or IABP+pVAD or pVAD+ECMO) use. We analyzed trends in use and in-hospital mortality with different type of combined MCS. Results Total of 6,11,170 patients were admitted with diagnosis of CS; out of which 21.9% underwent single MCS and 1.3% underwent combined MCS device. In-hospital mortality was higher in combined MCS vs single MCS use in both ischemic (51.1% vs 20.1%; p Conclusion We observed an increase in utilization of ECMO+pVAD during the study period 2010-2015. Combined use of MCS was associated with higher in-hospital mortality in both ICM and NICM in comparison to single MCS use. Further studies are needed to validate these outcomes and to determine associated risk factors.