Percutaneous ventricular assist during aortic valvuloplasty: potential application to the deployment of aortic stent-valves

Tex Heart Inst J. 2007;34(1):36-40.

Abstract

We evaluated the short-term safety and efficacy of using the TandemHeart(R) percutaneous ventricular assist device in high-risk patients undergoing aortic valvuloplasty procedures. Aortic valvuloplasty was performed in 4 patients who had no ventricular assist device support and in 7 patients who used the TandemHeart for hemodynamic support. The age range was 65 to 94 years (mean, 83 +/- 11 yr). The mean ejection fraction was 0.30 +/- 0.14. A transseptal antegrade approach to the aortic valve was used in 8 patients and a retrograde approach in the remaining 3. WITH THE TANDEMHEART, ALL PROCEDURES WERE TECHNICALLY SUCCESSFUL: each patient survived at least 1 month after the procedure. The mean total balloon inflation time was 37 +/- 10 sec. The aortic valve area was 0.6 +/- 0.1 cm(2) before the procedure and 0.9 +/- 0.2 cm(2) afterwards (P=0.006). Without TandemHeart support, 1 patient died of cardiac arrest during the procedure. The mean total balloon inflation time was 11 +/- 3 sec. Aortic valve area was 0.6 +/- 0 cm(2) before the procedure and 1.1 +/- 0.3 cm(2) afterwards (P=0.3). No patient developed aortic regurgitation. We conclude that use of the TandemHeart for hemodynamic support during high-risk aortic valvuloplasty is associated with favorable intraprocedural and short-term outcomes. With the TandemHeart in place, balloon placement was precise, and inflation was maintained for up to 45 sec without balloon displacement. These attributes are essential during stent-valve placement, are achieved without rapid ventricular pacing, and may reduce the risk of global ischemia and death.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / therapy*
  • Catheterization / instrumentation*
  • Equipment Design
  • Equipment Safety
  • Female
  • Follow-Up Studies
  • Heart Valve Prosthesis Implantation / instrumentation
  • Heart-Assist Devices*
  • Humans
  • Los Angeles
  • Male
  • Middle Aged
  • Stents*
  • Stroke Volume
  • Survival Analysis
  • Time Factors
  • Treatment Outcome