Cooper Adds Percutaneous Ventricular Assist Device: Revolutionary Technology Supports High-Risk and Cardiogenic Shock Patients During Revascularization

Primary percutaneous coronary intervention (PCI) has emerged as the treatment of choice in acute myocardial infarction with ST-segment elevation. However, in certain high-risk patients, circulatory support may be required during revascularization. The Cooper Heart Institute recently became the first advanced cardiac center in the Delaware Valley to provide access to percutaneous treatment for these patients using support from the TandemHeart™, Cardiac Assist, Inc.

Tandem Heart“There was an obvious need to provide circulatory support for patients who could not tolerate general anesthesia and cardiopulmonary bypass,” says Janah Aji, M.D., director of the Cooper Heart Institute’s Cardiac Catheterization Laboratory. “The TandemHeart™ system provides a percutaneous option for complex patients, such as patients withc ardiogenic shock, or those with unprotected left main coronary artery disease. This population has a relatively high risk of perioperative mortality and death when coupled with comorbidities, so the TandemHeart™ provides another treatment avenue for these patients,” he added.

A percutaneous ventricular assist device (pVAD), the TandemHeart™ is designed for rapid insertion (under 30 minutes) through femoral access, in either the cardiac catheterization lab or operating room. It is a continuousflow centrifugal pVAD with a heparinized fluid infusion system. One cannulae is inserted in the femoral vein and advanced under fluoroscopy to the left atrium via a transseptal puncture; an outflow cannula is inserted into the femoral artery. Support with the pVAD is usually short term, several hours to two days, depending on the hemodynamic needs of the patient. Its uses include:

  • Cardiogenic shock and acute decompensation
  • Large acute MI
  • High-risk revascularization (left main, or low ejection fraction)
  • High-risk surgery
  • Post-cardiotomy support
  • Beating heart coronary artery bypass graft (CABG)
  • Ventricular septal defect (VSD) stabilization

Cardiogenic Shock
AjiCardiogenic shock is defined as inadequate tissue perfusion resulting from cardiac dysfunction, with specific hemodynamic parameters: a sustained systolic blood pressure of <90mmHg, a cardiac index of < 2.2 L/min/m2, and a pulmonary capillary wedge pressure (PCWP) >15mmHg. A myriad of causes can be associated with cardiogenic shock, however, nearly 75% are secondary to pump failure. The incidence of cardiogenic shock within the acute myocardial infarction population has remained at approximately 7%, even as reperfusion strategies have decreased mortality rates from a high of 90% in 1970, to 40% in 2005. “It remains the leading cause of mortality in acute myocardial infarction,” says Joseph E. Parrillo, M.D., director of the Cooper Heart Institute and one of the world’s experts in the diagnosis and treatment of cardiogenic shock.

The percutaneous ventricular assist device (pVAD) is designed to provide temporary support needed by the cardiogenic shock patient, including:

  • Increase mean arterial pressure (MAP) and cardiac output (CO)
  • Reduce myocardial oxygen demand
  • Reduce pulmonary capillary wedge pressure (PCWP) and left atrial pressure (LAP)
  • Rapid percutaneous deployment of hemodynamic support during high-risk emergent revascularization
  • Circulatory stabilization of acute heart failure patients to improve systemic perfusion

Cooper Transfer System (COTS)
Rapid reperfusion and hemodynamic support are critical to the survival of the AMI population. The Cooper Transfer System, or COTS, was established in 2002 to address the critical care needs of South Jersey. “More than 2000 patients have been urgently transferred since its inception in 2002,” says Dr. Parrillo. “Of those transfers, more than 50% have been acute cardiac patients. Technology such as the TandemHeart™ allows us to provide the most advanced care available in the field today.”

To learn more about percutaneous ventricular assist devices, to speak to Dr. Aji or Dr. Parrillo, or to refer a patient, please call (856)342-2034. To contact COTS for a transfer patient, please call toll free 24/7: 1-866-723-COTS (2687).