Utilization of TandemHeart in cardiogenic shock: Insights from the THEME registry

Background TandemHeart has been demonstrated to improve hemodynamic and metabolic complications in cardiogenic shock (CS). Contemporary outcomes have not been reported. Objectives To evaluate the outcomes of the TandemHeart (LivaNova) in contemporary real‐world use. Methods We analyzed baseline char...

Full description

Saved in:
Bibliographic Details
Published in:Catheterization and cardiovascular interventions 2023-03, Vol.101 (4), p.756-763
Main Authors: Megaly, Michael, Gandolfo, Chaun, Zakhour, Samer, Jiang, Mei, Burgess, Kristie, Chetcuti, Stanley, Ragosta, Michael, Adler, Eric, Coletti, Andrew, O'Neill, Brian, Alaswad, Khaldoon, Basir, Mir B.
Format: Article
Language:English
Subjects:
cardiogenic shock
Confidence intervals
Heart-Assist Devices - adverse effects
Hemodynamics
Humans
Lactic acid
Prospective Studies
Registries
Shock, Cardiogenic - therapy
Survival
TandemHeart
TandemLife
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background TandemHeart has been demonstrated to improve hemodynamic and metabolic complications in cardiogenic shock (CS). Contemporary outcomes have not been reported. Objectives To evaluate the outcomes of the TandemHeart (LivaNova) in contemporary real‐world use. Methods We analyzed baseline characteristics, hemodynamic changes, and outcomes of all patients treated with TandemHeart who were enrolled in the THEME registry, a multicenter, prospective, observational study. Results Between May 2015 and June 2019, 50 patients underwent implantation of the TandemHeart device. 22% of patients had TandemHeart implanted within 12 h, 32% within 24 h, and 52% within 48 h of CS diagnosis. Cardiac index (CI) was significantly improved 24 h after implantation (median change 1.0, interquartile range (IQR) (0.5−1.4 L/min/m2). In survivors, there was a significant improvement in CI (1.0, IQR (0.5−2.25 L/min/m2) and lactate clearance −2.3 (−5.0 to −0.7 mmol/L). The 30‐day and 180‐day survival were 74% (95% confidence interval: 60%−85%) and 66% (95% confidence interval: 51%−79%), respectively. Survival was similarly high in those in whom TandemHeart has been used as a bridge to surgery (85% 180‐day survival). Conclusion In a contemporary cohort of patients presenting in CS, the use of TandemHeart is associated with a 74% 30‐day survival and a 66% 180‐day survival. Clinical Perspective What is known: Cardiogenic shock (CS) mortality remains high despite advancements in therapies. Early identification and placement of mechanical circulatory support are associated with improved survival in CS patients. What is new: CS patients treated with TandemHeart had 66% survival at 180 days in the THEME registry. TandemHeart was a bridge‐to‐LVAD in 24% of patients and a bridge‐to‐transplant in 2%. Most of these patients survived to 180 days (85%). Approximately 22% of patients had TandemHeart support within 12 h, and 52% within 48 h of shock diagnosis. What is next: Further studies are required to identify patients who would benefit from early aggressive support with TandemHeart and those who would benefit from surgical destination therapy. More efforts are needed for the early identification and support of CS patients.
ISSN:1522-1946
1522-726X
DOI:10.1002/ccd.30582