Satya S Shreenivas1, Scott M Lilly1, Wilson Y Szeto2, Nimesh Desai2, Saif Anwaruddin1, Joseph E Bavaria2, Kristin M Hudock3, Vinod H Thourani4, Raj Makkar5, Augusto Pichard6, John Webb7, Todd Dewey8, Samir Kapadia9, Rakesh M Suri10, Ke Xu11, Martin B Leon11,12, Howard C Herrmann1. 1. Department of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. 2. Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. 3. Department of Pulmonary and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania. 4. Emory University School of Medicine, Atlanta, Georgia. 5. Cedars-Sinai Medical Center, Los Angeles, California. 6. Medstar Washington Hospital Center, Washington, District of Columbia. 7. St. Paul's Hospital, Vancouver, British Columbia, Canada. 8. Medical City Dallas Hospital, Dallas, Texas. 9. Cleveland Clinic Foundation, Cleveland, Ohio. 10. Mayo Clinic, Rochester, Minnesota. 11. Cardiovascular Research Foundation, New York, New York. 12. Columbia University Medical Center/New York Presbyterian Hospital, New York, New York.
Abstract
BACKGROUND:Transcatheter aortic valve replacement (TAVR) with the balloon-expandable Sapien transcatheter heart valve improves survival compared to standard therapy in patients with severe aortic stenosis (AS) and is noninferior to surgical aortic valve replacement (AVR) in patients at high operative risk. Nonetheless, a significant proportion of patients may require pre-emptive or emergent support with cardiopulmonary bypass (CPB) and/or intra-aortic balloon pump (IABP) during TAVR due to pre-existing comorbid conditions or as a result of procedural complications. OBJECTIVES: We hypothesized that patients who required CPB or IABP would have increased periprocedural complications and reduced long-term survival. In addition, we sought to determine whether preprocedural variables could predict the need for CPB and IABP. METHODS: The study population included 2,525 patients in the PARTNER Trial (Cohort A and B) and the continuing access registry (CAR). Patients that received CPB or IABP were compared to patients that did not receive either, and then further divided into those that received support pre-TAVR and those that were placed on support emergently. RESULTS:One-hundred sixty-three patients (6.5%) were placed on CPB and/or IABP. The use of CPB or IABP was associated with higher 1 year mortality (49.1% vs. 21.6%, P < 0.001). In multivariable analysis, utilization of CPB or IABP was an independent predictor of 30 day (HR 6.95) and 1-year (HR 2.56) mortality. Although mortality was highest in emergent cases, mortality was also greater in planned CPB and IABP cases compared with non-CPB/IABP cases (53.3% and 40.3% vs. 21.6%, P < 0.001). CONCLUSIONS: These findings indicate that CPB and IABP use in TAVR portends a poor prognosis and its utilization, particularly in the setting of pre-emptive use, needs reconsideration.
RCT Entities:
BACKGROUND: Transcatheter aortic valve replacement (TAVR) with the balloon-expandable Sapien transcatheter heart valve improves survival compared to standard therapy in patients with severe aortic stenosis (AS) and is noninferior to surgical aortic valve replacement (AVR) in patients at high operative risk. Nonetheless, a significant proportion of patients may require pre-emptive or emergent support with cardiopulmonary bypass (CPB) and/or intra-aortic balloon pump (IABP) during TAVR due to pre-existing comorbid conditions or as a result of procedural complications. OBJECTIVES: We hypothesized that patients who required CPB or IABP would have increased periprocedural complications and reduced long-term survival. In addition, we sought to determine whether preprocedural variables could predict the need for CPB and IABP. METHODS: The study population included 2,525 patients in the PARTNER Trial (Cohort A and B) and the continuing access registry (CAR). Patients that received CPB or IABP were compared to patients that did not receive either, and then further divided into those that received support pre-TAVR and those that were placed on support emergently. RESULTS: One-hundred sixty-three patients (6.5%) were placed on CPB and/or IABP. The use of CPB or IABP was associated with higher 1 year mortality (49.1% vs. 21.6%, P < 0.001). In multivariable analysis, utilization of CPB or IABP was an independent predictor of 30 day (HR 6.95) and 1-year (HR 2.56) mortality. Although mortality was highest in emergent cases, mortality was also greater in planned CPB and IABP cases compared with non-CPB/IABP cases (53.3% and 40.3% vs. 21.6%, P < 0.001). CONCLUSIONS: These findings indicate that CPB and IABP use in TAVR portends a poor prognosis and its utilization, particularly in the setting of pre-emptive use, needs reconsideration.
Authors: Manuel Mendez-Bailon; Noel Lorenzo-Villalba; Nuria Muñoz-Rivas; Jose Maria de Miguel-Yanes; Javier De Miguel-Diez; Josep Comín-Colet; Valentin Hernandez-Barrera; Rodrigo Jimenez-Garcia; Ana Lopez-de-Andres Journal: Cardiovasc Diabetol Date: 2017-11-09 Impact factor: 9.951
Authors: Saraschandra Vallabhajosyula; Sri Harsha Patlolla; Harigopal Sandhyavenu; Saarwaani Vallabhajosyula; Gregory W Barsness; Shannon M Dunlay; Kevin L Greason; David R Holmes; Mackram F Eleid Journal: J Am Heart Assoc Date: 2018-07-09 Impact factor: 5.501