A Fellow’s Take on Technology: Looking Closer at the CardioMems and CardioHelp Devices
One of the benefits of interventional cardiology fellowship training is the exposure to new technology. Two newly approved devices—the CardioMems heart failure monitoring system (St Jude Medical) and the CardioHelp heart-lung support system (Maquet)—have impressed me so much so that I’d like to share my experiences with them.
Changing Treatment for Heart Failure
The CardioMems system is FDA approved for patients with NYHA class III heart failure symptoms and who were hospitalized for decompensated heart failure within the last year. The device is placed via venous access—usually the femoral vein—using a 12-Fr sheath. Right heart catheterization is performed using a 7-Fr balloon wedge pressure catheter, and then an angiogram of the left lower pulmonary artery is performed and selected for implantation of the device. The balloon wedge pressure catheter is removed, and the delivery system is advanced over a 0.018” guidewire into the lower lateral branch of the left pulmonary artery. Then the device, which is radio-opaque, is deployed after positioning is confirmed with contrast injection. The balloon wedge pressure catheter is reinserted, and pulmonary pressure recorded and calibrated with the CardioMems device. Afterward, clopidogrel is given for 30 days.
The CHAMPION trial showed a 37% reduction in heart failure-related hospitalizations using the CardioMems system compared with standard therapy. David M. Shavelle, MD, co-author of the CHAMPION trial, is one of my mentors at the University of Southern California and introduced the technology at our institution and to me. I believe every interventional fellow should learn its importance as it is part of the future of heart failure optimization.
Portable Hemodynamic Support
The CardioHelp device is the smallest portable heart-lung support system designed for patients needing extended circulatory and/or respiratory support without the need of a perfusionist. It can be inserted in the cath lab and offers cardiac output up to 5 L/min. Veno-arterial CardioHelp can be used in cardiogenic shock, massive pulmonary embolism with RV strain, for transport between facilities, and in high-risk PCI with severely depressed LVEF. Alternatively, veno-venous CardioHelp can be used in respiratory failure due to adult respiratory distress syndrome.
My institution was among the first county facilities in the country to involve the CardioHelp device in a patient with multivessel CAD and LVEF of 20% who was deemed too high risk for revascularization by cardiothoracic surgery. Our second case was a patient who presented with inferior STEMI and multivessel CAD with depressed LVEF that was complicated by thrombosis of the entire RCA and cardiogenic shock. CardioHelp proved to be life-saving. I love this technology, because it offers more hemodynamic support than the Impella 2.5 (Abiomed) and is easier to insert than the TandemHeart device (CardiacAssist), which offers similar hemodynamic support. It is also very convenient to perform this procedure in the cath lab independent of a perfusionist.
These new technologies in interventional cardiology are fascinating to learn during fellowship training and can prove useful when pursuing a future career, especially at a tertiary care center with similar technology. Fellows should talk to their interventional staff about introducing these technologies at their institutions and using them regularly. With practice, they can feel comfortable doing these procedures.
Note: Elsayed reports no relevant conflicts of interest with any of the devices mentioned.