Trenkwalder, Teresa and Pellegrini, Costanza and Holzamer, Andreas and Rheude, Tobias and Riester, Josef and Reinhard, Wibke and Mayr, N. Patrick and Kasel, Albert M. and Gaede, Luise and Blumenstein, Johannes and Kastrati, Adnan and Schunkert, Heribert and Joner, Michael and Hilker, Michael and Hengstenberg, Christian and Husser, Oliver (2019) Prophylactic ECMO during TAVI in patients with depressed left ventricular ejection fraction. CLINICAL RESEARCH IN CARDIOLOGY, 108 (4). pp. 366-374. ISSN 1861-0684, 1861-0692
Full text not available from this repository. (Request a copy)Abstract
BackgroundThis study investigated the impact of prophylactic veno-arterial extracorporeal membrane oxygenation (pECMO) in patients with depressed left ventricular ejection fraction (dLVEF) undergoing transcatheter aortic valve implantation (TAVI).MethodsOut of 1490 patients undergoing TAVI at two centers (2010-2015), 222 patients had dLVEF (40%). Of these, 21 patients (10%) underwent TAVI with pECMO. Complications and outcome according to pECMO were analyzed in the entire and in a propensity-matched population.ResultsIn the entire population, patients with pECMO had a higher logEuroScore I (33% 19 vs. 25% +/- 17; p=0.037), worse LVEF (26% +/- 7 vs. 32% +/- 7; p=0.001), more major bleedings (29% vs. 9%; p=0.015), higher transfusion rate (30% vs. 10%; p=0.019) and longer in-hospital stay (9.0 [7.0;14.0] vs. 7.0 [5.0;10.0] days; p=0.024). After propensity matching only transfusion rate remained higher with pECMO (30% vs. 7%; p=0.025). In the entire population, rate and risk of 30-day mortality was higher with pECMO (24% vs. 6%, HR 95%CI 4.29 [1.51-12.19]; p=0.006). In the matched population, this effect was attenuated (24% vs. 12%, HR 95%CI 2.09 [0.61-7.23]; p=0.243). Cumulative rate and risk of 1-year mortality did not differ in the entire (log-rank p=0.069; 39% vs. 22%, HR 95%CI 1.99 [0.94-4.24]; p=0.074) nor in the matched population (log-rank p=0.520; 39% vs. 31%, HR 95%CI 1.34 [0.55-3.28]; p=0.523).Conclusionp id=Par4In patients with dLVEF undergoing TAVI, periprocedural pECMO support does not seem to improve patient outcome.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | AORTIC-VALVE IMPLANTATION; EXTRACORPOREAL MEMBRANE-OXYGENATION; LOW-FLOW; CARDIOPULMONARY BYPASS; CONTRACTILE RESERVE; RISK STRATIFICATION; TRANSCATHETER; GRADIENT; REPLACEMENT; STENOSIS; Depressed left ventricular function; Aortic stenosis; TAVI; ECMO; Multidisciplinary Heart Team |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Herz-, Thorax- und herznahe Gefäßchirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 16 Apr 2020 05:22 |
| Last Modified: | 16 Apr 2020 05:22 |
| URI: | https://pred.uni-regensburg.de/id/eprint/27293 |
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