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Discussion

LVADs in the cath lab

We found out his morning that we will be palcing an LVAD next Monday. Thing is none of us have any experience in using this device. they wanted to do it today with no training, no plan for recovery care, nothing. fortunately our manager said no.

So, my question is... who out there in cath labs is placing these devices for PCI, not transplant?

What are your policies, who is involved in the case, who takes care of the device and patient after the fact?

ANY information would be greatly appreciated.

tvccrn

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  • Guides

We place a couple of temporary LVADs in the cath lab - Abiomed's Impella, and the TandemHeart.

We have device engineers and nurses (I am one) who attend to prime, hand over and run the pump. The interventional cardiologists implant them, and sometimes one of our CT surgeons assists.

These are devices that are generally used just for support for PCIs and then weaned at the end of the case, so the patient goes back to CCU or CTICU without a device.

The companies are usually happy to send a clinical rep to assist you for the first few implants. Let me know which device you're interested in and I can send some cheat sheets that I've made for the setup and priming etc.

  • Author

It's Abiomed's Impella that we are going to be using. We have a rep here today that will be working with the team that is chosen to do the case next week with more training in the future.

Any info that you have would be very greatly appreciated.

The TandemHeart is a much better device. It provides greater flow. The Impella 2.5 may be easier to implant, but is not only more expensive, but it isn't any more effective thn the IABP.

  • Guides

Do you have any evidence for your statement that Tandem is a "much better device"??? On what criteria? Could you provide the study showing non-inferiority of Impella 2.5 with IABP?

Tandem does provide more than 2.5L of flow, but why do you need more than 2.5 L of flow if it's being used in the cath lab for high-risk PCI support? How is the Tandem any better than using Tandem trans-septal cannula with a Centrimag pump? That's even cheaper, provides even more flow, and doesn't require infusate lines.

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