Matthew Nardi, MD: No financial relationships to disclose
Background: Cardiogenic shock is a life-threatening condition with high mortality. Direct left ventricular unloading is widely utilized. However certain pathologies can limit utilization. Transeptal LA unloading is an alternative MCS in patients with CS. We performed analysis on the effect of unloading by means of Tandem Heart and clinical outcomes.
Methods: Retrospective analysis of data from 46 patients presenting with refractory CS who were supported via transeptal direct left atrial (LA) unloading (Tandem Heart) support between 2018-2024.
Outcome: 65% of the patients were male and the average age was 60±15 years. The median duration of support was 5.5 days. LA unloading led to significant improvement of right atrial (17±8 vs 10±5 mmHg, p< 0.0001) and pulmonary artery pressures (mean PA:36±10 vs 26±7, p=0.006; PA diastolic 27±10 vs 20±7 mmHg, p=0.02). TandemHeart support resulted in reduction of lactate (3.5±3 vs 2±2.8, p=0.009), and improvement of creatinine (2.2±1.7 vs 1.7±1.6, p=0.007) and liver enzymes (AST: 625±1127 vs140±327, p 0.005; ALT: 541±1052 vs 276±508, p=0.03). Thirty-two patients survived to hospital discharge (69.6%). Four patients were bridged to transplant and ten to durable LVAD. Eighteen patients had hemodynamic recovery with device removal.
Conclusion: Direct LA unloading by means of a continuous flow device resulted in reduction of cardiac filling pressures and improvement of end-organ function. Our findings support direct left atrial unloading as a bridge to advanced therapies or to recovery in selected patients whom are otherwise not candidates for transaortic LV unloading.
