Devices for Transcatheter Haemodynamic Support for Left Heart Failure

et al. 8 investigated the TandemHeart device in a randomised study against an IABP from August 2000 to December 2003 at a single site in Germany. The inclusion criteria were the presence of CS complicating AMI with the intention to revascularise the infarcted artery by PCI. Glycoprotein IIb/IIIa receptor antagonists were also recommended for thrombolysis in MI (TIMI) flow less than III or evidence of intracoronary thrombus after PCI. CS was defined by persistent systolic blood pressure <90mmHg or vasopressors required to maintain blood pressure >90mmHg, evidence of end-organ failure, evidence of elevated left ventricular filling pressure and cardiac index <2.1l/minute/m 2 . The exclusion criteria were age >75 years, mechanical complications of AMI, duration of CS >12 hours, right heart failure, sepsis, significant aortic regurgitation, severe cerebral damage, resuscitation >30 minutes, severe peripheral vascular disease and other diseases with reduced life expectancy; the exclusion criteria eliminated >50% of patients in CS in the study. The haemodynamic parameters measured were cardiac output, mean blood pressure, cardiac power index, mean pulmonary artery pressure, central venous pressure and heart rate. The metabolic parameters measured were standard base excess, serum lactate and pH. The study attempted to avoid limb ischaemia in smaller patients by recommending the use of 12Fr arterial cannulae instead of the usual 17Fr used in most patients, therefore limiting the flow from the system to 3l/minute compared with 4l/minute. The cannulae were removed using a surgical approach in the first eight patients and subsequent removal was manual using a compression system. Abstract Among patients with acute myocardial infarction (AMI), those in cardiogenic shock have the highest mortality rate. Early revascularisation with primary percutaneous intervention or coronary artery bypass surgery has decreased the mortality rate of patients in cardiogenic shock, but it remains high. The conventional treatment of haemodynamic instability has been the use of the intra-aortic balloon pump (IABP); however, the IABP may not give adequate support to patients with severe left ventricular dysfunction. Recent advances in percutaneous left ventricular assist devices, specifically the TandemHeart and Impella LP 2.5, have shown improved haemodynamic support compared with the IABP. This article provides an overview of the use of percutaneous left ventricular assist devices to treat patients presenting with cardiogenic shock after acute MI.