High-Risk Chronic Total Occlusion Percutaneous Coronary Interventions Assisted With Tandem Heart
Neupane S, Basir M, Alqarqaz M, O'Neill W, and Alaswad K. High-Risk Chronic Total Occlusion Percutaneous Coronary Interventions Assisted With Tandem Heart. J Am Coll Cardiol 2019; 74(13):B223.
J Am Coll Cardiol
Background: Mechanical circulatory support devices are increasingly used to avoid hemodynamic collapse during high-risk chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Intermediate-term outcomes of Tandem Heart (TH) supported CTO PCI has not been previously reported. Methods: We retrospectively evaluated procedural and clinical outcomes in consecutive patients undergoing elective or urgent TH-assisted CTO PCI at our institution from April 1, 2016, to January 30, 2019. Results: A total of 13 CTOs were performed with hemodynamic support using TH during the study period. TH was placed before PCI in all the procedures. The most common reason for hemodynamic support was the use of retrograde CTO PCI technique in the setting of LV dysfunction (5 [38%]). Eleven (92%) patients had decreased left ventricular function with severe congestive heart failure symptoms before the procedure. The CTO vessel treated was the right coronary artery (38%), followed by left anterior descending and left circumflex (31% each). A retrograde approach was utilized in 6 (46%) PCIs. Technical success was achieved in 12 (92%) PCIs despite very complex and very difficult CTO lesions as indicated by a median J-CTO score of 3 and Progress CTO score of 2. Procedure success was achieved in 10 (77%) patients. TH was removed at the completion of PCI in 11 (85%) patients. One patient developed AV fistula at the arterial cannula insertion site and there was no major bleeding complication. One patient had coronary perforation with hemodynamic compromise requiring pericardiocentesis. One patient developed severe persistent cardiogenic shock presumed to be secondary to RV wall hematoma and died after prolonged intensive care unit stay. Conclusion: TH can be safely used for hemodynamic support during CTO PCI to achieve very high technical success rate.