Kyokun Uehara1, Kenji Minakata2, Naritatsu Saito3, Masao Imai3, Hiroki Daijo4, Taro Nakatsu1, Kazuhisa Sakamoto1, Kazuhiro Yamazaki1, Takeshi Kimura3, Ryuzo Sakata1. 1. Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan. 2. Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan. minakata@kuhp.kyoto-u.ac.jp. 3. Department of Cardiology, Kyoto University Graduate School of Medicine, Kyoto, Japan. 4. Department of Anesthesiology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Abstract
OBJECTIVES: Although transcatheter aortic valve replacement (TAVR) is an excellent alternative procedure for high-risk patients with severe symptomatic aortic stenosis, it is often associated with life-threatening complications. We report on the emergency or elective use of veno-arterial extracorporeal membrane oxygenation (ECMO) to manage these complications. METHODS: Between December 2013 and February 2016, 46 patients underwent TAVR at our institution. Of these, 4 patients required emergency ECMO support and another 3 patients were electively placed on ECMO support at the start of the procedure. The mean age of the ECMO patients was 87.3 ± 3.6 years and all were female. The Society of Thoracic Surgeons-predicted risk of mortality score in these patients was 12.2 ± 6.2%. RESULTS: TAVR with ECMO was completed through the transapical approach in 6 patients, and the transfemoral approach in 1 patient. The arterial access route for ECMO was the femoral artery in 5, the external iliac artery in 1, and the subclavian artery in 1. Indications for the use of emergency ECMO were hemodynamic instability in 2, cardiogenic shock in 2, while indications for elective ECMO were severe pulmonary hypertension, impaired left ventricular function and a combination of these. There was no 30-day mortality, and the 1-year survival rate was 83.3% with no significant difference compared to patients without ECMO support. CONCLUSION: The use of ECMO in very high-risk patients undergoing TAVR may increase safety and contribute to excellent outcomes. Although ECMO support is rarely needed in TAVR, a well-prepared treatment strategy by the heart team is mandatory.
OBJECTIVES: Although transcatheter aortic valve replacement (TAVR) is an excellent alternative procedure for high-risk patients with severe symptomatic aortic stenosis, it is often associated with life-threatening complications. We report on the emergency or elective use of veno-arterial extracorporeal membrane oxygenation (ECMO) to manage these complications. METHODS: Between December 2013 and February 2016, 46 patients underwent TAVR at our institution. Of these, 4 patients required emergency ECMO support and another 3 patients were electively placed on ECMO support at the start of the procedure. The mean age of the ECMO patients was 87.3 ± 3.6 years and all were female. The Society of Thoracic Surgeons-predicted risk of mortality score in these patients was 12.2 ± 6.2%. RESULTS: TAVR with ECMO was completed through the transapical approach in 6 patients, and the transfemoral approach in 1 patient. The arterial access route for ECMO was the femoral artery in 5, the external iliac artery in 1, and the subclavian artery in 1. Indications for the use of emergency ECMO were hemodynamic instability in 2, cardiogenic shock in 2, while indications for elective ECMO were severe pulmonary hypertension, impaired left ventricular function and a combination of these. There was no 30-day mortality, and the 1-year survival rate was 83.3% with no significant difference compared to patients without ECMO support. CONCLUSION: The use of ECMO in very high-risk patients undergoing TAVR may increase safety and contribute to excellent outcomes. Although ECMO support is rarely needed in TAVR, a well-prepared treatment strategy by the heart team is mandatory.
Authors: Susheel K Kodali; Mathew R Williams; Craig R Smith; Lars G Svensson; John G Webb; Raj R Makkar; Gregory P Fontana; Todd M Dewey; Vinod H Thourani; Augusto D Pichard; Michael Fischbein; Wilson Y Szeto; Scott Lim; Kevin L Greason; Paul S Teirstein; S Chris Malaisrie; Pamela S Douglas; Rebecca T Hahn; Brian Whisenant; Alan Zajarias; Duolao Wang; Jodi J Akin; William N Anderson; Martin B Leon Journal: N Engl J Med Date: 2012-03-26 Impact factor: 91.245
Authors: Alain Cribier; Helene Eltchaninoff; Assaf Bash; Nicolas Borenstein; Christophe Tron; Fabrice Bauer; Genevieve Derumeaux; Frederic Anselme; François Laborde; Martin B Leon Journal: Circulation Date: 2002-12-10 Impact factor: 29.690
Authors: Ronen Gurvitch; Edgar L Tay; Namal Wijesinghe; J Ye; Fabian Nietlispach; David A Wood; Samuel Lichtenstein; Anson Cheung; John G Webb Journal: Catheter Cardiovasc Interv Date: 2011-06-07 Impact factor: 2.692
Authors: R Gurvitch; D A Wood; E L Tay; J Leipsic; J Ye; S V Lichtenstein; C R Thompson; R G Carere; N Wijesinghe; F Nietlispach; R H Boone; S Lauck; A Cheung; J G Webb Journal: Circulation Date: 2010-09-13 Impact factor: 29.690
Authors: Oliver Husser; Andreas Holzamer; Alois Philipp; Julio Nunez; Vicente Bodi; Thomas Müller; Matthias Lubnow; Andreas Luchner; Dirk Lunz; Günter A J Riegger; Christof Schmid; Christian Hengstenberg; Michael Hilker Journal: Catheter Cardiovasc Interv Date: 2013-04-29 Impact factor: 2.692
Authors: Javier Castrodeza; Ana Mª Serrador Frutos; Ignacio J Amat-Santos; Inés Sayago Silva; José Alberto San Román Journal: Cardiol J Date: 2019 Impact factor: 2.737
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
Authors: Petr Ostadal; Dagmar Vondrakova; Michaela Popkova; Matej Hrachovina; Andreas Kruger; Marek Janotka; Jan Naar; Otomar Kittnar; Petr Neuzil; Mikulas Mlcek Journal: Sci Rep Date: 2022-10-12 Impact factor: 4.996