Cardiac Intervention Supported by TandemHeart

This case involves a 61-year-old male who presented to the cardiac catheterization for a diagnostic catheterization to obtain information for the transplant service. Previous medical history included hypertension and coronary artery disease..

The diagnostic catheterization confirmed diffuse right sided disease with an ejection fraction of approximately 5-10%. During the catheterization, the patient experienced significant hemodynamic instability and was subsequently placed on an intraaortic balloon pump (IABP). A consult was placed for stenting of the right coronary artery and the patient was transported to the coronary care unit until the procedure could be performed. Due to the potentially high risk associated with the coronary intervention, the decision was made to utilize the TandemHeart System for backup support.

The patient returned to the cath lab and was prepped and draped as normal procedure. Arterial and venous access for the TandemHeart was achieved through the left groin since the IABP,as well as a venous sheath, were present in the right side from the previous catheterization. Although the patient had a patent foramen ovale (PFO), the cardiologist was unsuccessful in placing a wire through it, therefore transseptal access was achieved using the Brockenbrough needle approach. Once the transseptal cannula was placed, Angiomax was initiated, and the IABP was removed. This initially caused a decrease in blood pressure and Dopamine was started. The arterial cannula was placed without difficulty and TandemHeart support was initiated at 6000 RPM with a 2.5 LPM flow. Five minutes into support, the Dopamine infusion was discontinued and the intervention was started. Three stents were placed in the right coronary artery was well as one in the left anterior descending. Upon completion of the intervention, the TandemHeart System was discontinued without complication and the Dopamine infusion was restarted.

Total support was 145 minutes. The patient was transferred from the cath lab to the coronary care unit in stable condition. The following morning the patient was moved to a regular floor with discharge plans for the following day.