TandemHeart

Overview

TandemHeart is a percutaneous ventricular assist device (VAD) consisting of an extracorporeal centrifugal continuous flow pump that drains blood from the left atrium via a cannula introduced through the femoral vein and extended transseptally from the right atrium to the left atrium; blood is pumped back to the femoral artery at a flow rate of up to 4 L/min.

  • it is a percutaneous ventricular assist device
  • mostly used as a mechanical circulatory support device in cardiogenic shock
  • have an external centrifugal pump system
  • allows percutaneous LV support by pumping blood from the left atrium into the femoral artery at a flow rate of up to 4 L/min
  • placement of the 21F venous inflow cannula is performed in the cath lab by accessing the femoral vein percutaneously and positioning the cannula tip in the left atrium via an atrial transseptal puncture
  • outflow is established into the contralateral or ipsilateral femoral artery via a 15F or 17F cannula
  • centrifugal pump is attached to the patient’s tight adjacent to arterial cannula
  • the device has built-in heparin delivery system to decrease thrombin formation
  • more effective means of improving hemodynamic parameters in cardiogenic shock than IABP but no improvement in 30-day mortality has been demonstrated (1,2)
  • increases cardiac output and mean arterial pressure and decreases cardiac filling pressure by venting the left atrium
    • this effect might be partly offset by the increased left ventricular afterload due to retrograde blood flow up the aorta towards the aortic root
  • associated with improvement in hemodynamic and metabolic outcomes compared with an IABP in two small randomized trials
  • survival was not improved and more complications were seen in patients fitted with the TandemHeart

Indications

  • postcardiotomy failure
  • until corrective valvular surgery is performed
  • until recovery of fulminant myocarditis
  • bridge to LVAD or BTT
  • high-risk PCI

Contraindications

  • severe PVD
  • isolated right ventricular (RV) failure
  • VSD (risk for right-to-left shunt)

References

1 Thiele H, Sick P, Boudriot E, et al. Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J 2005;26:1276-83.

2 Burkhoff D, Cohen H, Brunckhorst C, O’Neill WW, TandemHeart Investigators G. A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock. Am Heart J 2006;152:469, e1-8.