Assisted circulation using the Tandemheart®, percutaneous transseptal left ventricular assist device, during percutaneous aortic valve implantation: The Rotterdam experience

Aims: The morbidity and mortality of surgical aortic valve replacement are increased in elderly patients with multiple high risk comorbid conditions. Percutaneous prosthetic aortic valve replacement (PAVR) via the femoral arterial approach is feasible in selected patients, who are poor operative candidates, with satisfactory short term outcomes. It is conceivable that patients with poor LV function may benefit from periprocedural cardio-circulatory support. We evaluated the short-term safety and efficacy of using the TandemHeart® PTVA® System (p-LVAD) to deliver extracorporeal circulatory support in patients undergoing PAVR. Methods and results: Between April 2006 and May 2007 the TandemHeart® was used in 10 patients (age: range 64-85, median 80) undergoing elective PAVR using the CoreValve™ Revalving System. The median (range) time for implementation of circulatory support was 32 (22-40) minutes. A pump flow up to 4.6 L/min was achieved. Systemic haemodynamics were maintained in all but one patient. The median (range) systemic arterial pressure (MBP) was 77 (67-89) mmHg at baseline and 76 (61-91) mmHg after pump functioning. A major systolic blood pressure drop (systolic blood pressure < 70 mmHg, pulse pressure < 10 mmHg, occurred in one patient due to PAVR related pericardial tamponade. Median (range) duration of support was 64 (60-93) minutes. Successful weaning was achieved in all patients. There was one in hospital death. Survival at 12 months was 90%, at 15 months 70%. Vascular access site complications were seen in two patients. One patient suffered a mild to moderate access site bleeding, one a local wound infection. There was no technical device failure. Conclusions: The TandemHeart-PTVA® may provide a valuable safeguard during high risk PAVR procedures and enables precise delivery of the CoreValve prosthesis. The rate of device related cardiac and vascular complications was acceptable.