Trenkwalder, Teresa and Pellegrini, Costanza and Holzamer, Andreas and Philipp, Alois and Rheude, Tobias and Michel, Jonathan and Reinhard, Wibke and Joner, Michael and Kasel, Albert M. and Kastrati, Adnan and Schunkert, Heribert and Endemann, Dierk and Debl, Kurt and Mayr, N. Patrick and Hilker, Michael and Hengstenberg, Christian and Husser, Oliver (2018) Emergency extracorporeal membrane oxygenation in transcatheter aortic valve implantation: A two-center experience of incidence, outcome and temporal trends from 2010 to 2015. CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 92 (1). pp. 149-156. ISSN 1522-1946, 1522-726X
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Background: Although the incidence of periprocedural complications has decreased in transcatheter aortic valve implantation (TAVI), life-threatening complications occur and emergency veno-arterial extracorporeal membrane oxygenation (vaECMO) can provide immediate circulatory stabilization. We report our two-center experience of vaECMO during life-threatening complications in TAVI. Methods: From January 2010 to December 2015, 1,810 consecutive patients underwent TAVI at two centers. Clinical characteristics, type of complication, outcome and temporal trends in the requirement of emergency vaECMO were evaluated. Results: Life-threatening complications requiring vaECMO occurred in 1.8% of cases (33 patients; 22 transfemoral, 11 transapical). Indications for vaECMO were ventricular rupture (30%, 10/33), low output (15%, 5/33), bleeding (12%, 4/33), coronary artery impairment (9%, 3/33), ventricular arrhythmias (6%, 2/33), severe aortic regurgitation (6%, 2/33), aortic annular rupture (6%, 2/33), and aortic dissection (3%, 1/33). In 4 cases, no definite cause for hemodynamic instability was identified. Conversion to open heart surgery was necessary in 42% of patients (14/33). Percutaneous coronary intervention was performed in all cases with coronary artery impairment (9%, 3/33). Patients with severe aortic regurgitation (6%, 2/33) underwent emergency valve-in-valve implantation. Other patients received, in addition to vaECMO support conservative treatment (42%, 14/33). In-hospital mortality and 30-day mortality were 46% (15/33). Of patients discharged, 67% (12/18) had no neurological impairment, whereas mild and severe neurological impairment was found in 11% (2/18) and 22% (4/18), respectively. From 2010 to 2015, with increasing procedures (from n = 43 to n = 553) requirement of vaECMO decreased from 9.3% to 0.9% (P for the trend <0.001). Conclusion: Over a 6-year period, need for emergency vaECMO during TAVI significantly decreased over time. Despite high in-hospital mortality, vaECMO represents a feasible strategy for hemodynamic support in case of life-threatening complications.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | MECHANICAL CIRCULATORY SUPPORT; INTERMEDIATE-RISK PATIENTS; CARDIOGENIC-SHOCK; CONSENSUS DOCUMENT; HEART-VALVE; REPLACEMENT; STENOSIS; COMPLICATIONS; REGISTRY; SURGERY; extracorporeal membrane oxygenation; procedural complications; transcatheter aortic valve implantation |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Herz-, Thorax- und herznahe Gefäßchirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 02 Mar 2020 08:52 |
| Last Modified: | 02 Mar 2020 08:52 |
| URI: | https://pred.uni-regensburg.de/id/eprint/14276 |
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