TandemHeart insertion via a femoral arterial GORE-TEX graft conduit in a high-risk patient

Jonas Busch, Guillermo Torre-Amione, George P. Noon, Matthias Loebe

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

The TandemHeart® percutaneous ventricular assist device (pVAD), which provides temporary circulatory support of the left ventricle, can be used in high-risk and hemodynamically unstable patients. The easily inserted TandemHeart provides cardiac support superior to that from the use of intra-aortic balloon pumps. Herein, we discuss TandemHeart implantation via end-to-side femoral arterial grafting in a cardiac patient whose sepsis and multiorgan failure were complicated by coagulopathy and thromboembolism. A 47-year-old woman, on intra-aortic balloon and intravenous inotropic support after an acute myocardial infarction and emergency coronary artery bypass grafting, was transferred to our institution via helicopter. She developed sepsis and multiorgan failure. Her condition was further complicated by coagulopathy and a left-lower-extremity thromboembolism. After 6 weeks of aggressive pharmacologic and intermittent intra-aortic balloon treatment, the patient developed cardiogenic shock and received a TandemHeart pVAD for short-term circulatory support. A GORE-TEX® access graft, sewn end-to-side to the femoral artery because of the patient's leg ischemia and very small vessels, served as a conduit for the TandemHeart's femoral arterial inflow cannula. Her difficult circulatory, anatomic, and coagulopathic status stabilized after 2 weeks of TandemHeart support, and she was bridged to the long-term MicroMed DeBakey VAD® Child in anticipation of heart transplantation. The case of our patient shows that high-risk patients who have experienced cardiogenic shock with multiorgan failure and coagulopathy can benefit from the TandemHeart pVAD as a bridge to other therapeutic options, even when creative approaches to treatment and to TandemHeart insertion are required.

Original languageEnglish (US)
Pages (from-to)462-465
Number of pages4
JournalTexas Heart Institute Journal
Volume35
Issue number4
StatePublished - 2008
Externally publishedYes

Fingerprint

Polytetrafluoroethylene
Thigh
Transplants
Heart-Assist Devices
Cardiogenic Shock
Thromboembolism
Sepsis
Aircraft
Femoral Artery
Heart Transplantation
Coronary Artery Bypass
Heart Ventricles
Lower Extremity
Leg
Emergencies
Therapeutics
Ischemia
Myocardial Infarction

Keywords

  • Cardiac output, low/therapy
  • Equipment design
  • Heart failure/surgery/therapy
  • Heart valve prosthesis implantation/methods
  • Heart-assist devices
  • Patient selection
  • Risk factors
  • Shock, cardiogenic/therapy
  • Treatment outcome
  • Ventricular dysfunction, left/therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

TandemHeart insertion via a femoral arterial GORE-TEX graft conduit in a high-risk patient. / Busch, Jonas; Torre-Amione, Guillermo; Noon, George P.; Loebe, Matthias.

In: Texas Heart Institute Journal, Vol. 35, No. 4, 2008, p. 462-465.

Research output: Contribution to journalArticle

Busch, Jonas ; Torre-Amione, Guillermo ; Noon, George P. ; Loebe, Matthias. / TandemHeart insertion via a femoral arterial GORE-TEX graft conduit in a high-risk patient. In: Texas Heart Institute Journal. 2008 ; Vol. 35, No. 4. pp. 462-465.
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abstract = "The TandemHeart{\circledR} percutaneous ventricular assist device (pVAD), which provides temporary circulatory support of the left ventricle, can be used in high-risk and hemodynamically unstable patients. The easily inserted TandemHeart provides cardiac support superior to that from the use of intra-aortic balloon pumps. Herein, we discuss TandemHeart implantation via end-to-side femoral arterial grafting in a cardiac patient whose sepsis and multiorgan failure were complicated by coagulopathy and thromboembolism. A 47-year-old woman, on intra-aortic balloon and intravenous inotropic support after an acute myocardial infarction and emergency coronary artery bypass grafting, was transferred to our institution via helicopter. She developed sepsis and multiorgan failure. Her condition was further complicated by coagulopathy and a left-lower-extremity thromboembolism. After 6 weeks of aggressive pharmacologic and intermittent intra-aortic balloon treatment, the patient developed cardiogenic shock and received a TandemHeart pVAD for short-term circulatory support. A GORE-TEX{\circledR} access graft, sewn end-to-side to the femoral artery because of the patient's leg ischemia and very small vessels, served as a conduit for the TandemHeart's femoral arterial inflow cannula. Her difficult circulatory, anatomic, and coagulopathic status stabilized after 2 weeks of TandemHeart support, and she was bridged to the long-term MicroMed DeBakey VAD{\circledR} Child in anticipation of heart transplantation. The case of our patient shows that high-risk patients who have experienced cardiogenic shock with multiorgan failure and coagulopathy can benefit from the TandemHeart pVAD as a bridge to other therapeutic options, even when creative approaches to treatment and to TandemHeart insertion are required.",
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