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Abstracts: ASAIO Cardiac Abstracts

USE OF PERCUTANEOUS LEFT VENTRICULAR ASSIST DEVICE TO SUPPORT PERCUTANEOUS AORTIC VALVE IMPLANTATION

Kar, Biswajit1; Delgado, Reynolds1; Radovancevic, Branislav1; Robert, Katherine1; Tamez, Daniel1; Tuzun, Egemen1; Fish, R D1; Paniagua, David1

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Balloon percutaneous aortic heart valve (PAHV) implantation causes hemodynamic collapse due to left ventricular outflow tract (LVOT) occlusion. We sought to investigate whether the percutaneous left ventricular assist device (PLVAD), TandemHeart®, can prevent hemodynamic collapse, perfuse coronaries, and unload the left ventricle to facilitate percutaneous valve placement.

Methods

Sheep (n=4) weighing 67±20kg underwent placement of a PLVAD before transcatheter implantation of a PAHV. One femoral vein was used for an intravascular echo(Accuson®) to provide guidance during transseptal puncture(TP). The left femoral vein was used for the PLVAD inflow. The right femoral artery was used for the PLVAD outflow and the left for hemodynamic and angiographic evaluation. The right carotid artery was used for insertion of the PAHV. Balloon inflation was performed to secure the PAHV within the aortic annulus with PLVAD support.

Results

PAHV was succesfully implanted in all 4 studies. Aortic pressure(AoP) prior to inflation was 77±31mmHg and PLVAD flow was 2.14±0.76L/min. During PAHV implantion, the AoP was 57±14mmHg and PLVAD flow was 2.26±0.52L/min. Post-PAHV implant, the AoP was 69±21mmHg and PLVAD flow was 2.74±0.76L/min. Aortograms performed during PAHV placement show coronary perfusion with PLVAD support.

Conclusion

PLVAD support prevents hemodynamic collapse, perfuses coronaries during LVOT occlusion, and unloads the left ventricle to facilitate percutaneous aortic valve replacement.

Copyright © 2005 by the American Society for Artificial Internal Organs