Vikas Singh1, Pradeep K Yadav2, Marvin H Eng3, Francisco Yuri Macedo4, Guilherme V Silva5, Rodrigo Mendirichaga6, Amit P Badiye6, Rahul Sakhuja7, Sammy Elmariah7, Ignacio Inglessis7, Carlos E Alfonso6, Theodore L Schreiber8, Mauricio Cohen6, Igor Palacios7, William W O'Neill3. 1. Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: vikas.dr.singh@gmail.com. 2. Penn State Milton S. Hershey Medical Center, Hershey, PA, United States. 3. Henry Ford Hospital, Detroit, MI, United States. 4. Baylor College of Medicine, Houston, TX, United States. 5. Baylor College of Medicine, Houston, TX, United States; Texas Heart Institute, Houston, TX, United States. 6. University of Miami Miller School of Medicine, Miami, FL, United States. 7. Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States. 8. Detroit Medical Center and Wayne State University, Detroit, MI, United States.
Abstract
BACKGROUND: Reports on the role of hemodynamic support devices in patients with severe aortic stenosis (AS) and left ventricular (LV) dysfunction undergoing balloon aortic valvuloplasty (BAV) are limited. METHODS: Patients were identified from the cVAD registry, an ongoing multicenter voluntary registry at selected sites in North America that have used Impella in >10 patients. RESULTS: A total of 116 patients with AS who underwent BAV with Impella support were identified. Mean age was 80.41±9.03years and most patients were male. Mean STS score was 18.77%±18.32, LVEF was 27.14%±16.07, and 42% underwent concomitant PCI. In most cases Impella was placed electively prior to BAV, whereas 26.7% were placed as an emergency. The two groups had similar baseline characteristics except for higher prevalence of CAD and lower LVEF in the elective group, and higher STS score in the emergency group. Elective strategy was associated higher 1-year survival compared to emergency placement (56% vs. 29.2%, p=0.003). One-year survival was higher when BAV was used as a bridge to definitive therapy as opposed to palliative treatment (90% vs. 28%, p<0.001). On multivariate analysis, STS score and aim of BAV (bridge to definitive therapy vs. palliative indication) were independent predictors of mortality. CONCLUSION: In this large cohort of patients with AS and severe LV dysfunction undergoing BAV, our results demonstrates feasibility and promising long-term outcomes using elective Impella support with the intention to bridge to a definitive therapy.
BACKGROUND: Reports on the role of hemodynamic support devices in patients with severe aortic stenosis (AS) and left ventricular (LV) dysfunction undergoing balloon aortic valvuloplasty (BAV) are limited. METHODS:Patients were identified from the cVAD registry, an ongoing multicenter voluntary registry at selected sites in North America that have used Impella in >10 patients. RESULTS: A total of 116 patients with AS who underwent BAV with Impella support were identified. Mean age was 80.41±9.03years and most patients were male. Mean STS score was 18.77%±18.32, LVEF was 27.14%±16.07, and 42% underwent concomitant PCI. In most cases Impella was placed electively prior to BAV, whereas 26.7% were placed as an emergency. The two groups had similar baseline characteristics except for higher prevalence of CAD and lower LVEF in the elective group, and higher STS score in the emergency group. Elective strategy was associated higher 1-year survival compared to emergency placement (56% vs. 29.2%, p=0.003). One-year survival was higher when BAV was used as a bridge to definitive therapy as opposed to palliative treatment (90% vs. 28%, p<0.001). On multivariate analysis, STS score and aim of BAV (bridge to definitive therapy vs. palliative indication) were independent predictors of mortality. CONCLUSION: In this large cohort of patients with AS and severe LV dysfunction undergoing BAV, our results demonstrates feasibility and promising long-term outcomes using elective Impella support with the intention to bridge to a definitive therapy.
Authors: Mohamad Alkhouli; Ahmed Al Mustafa; Zakeih Chaker; Fahad Alqahtani; Sami Aljohani; David R Holmes Journal: J Card Surg Date: 2017-03-07 Impact factor: 1.620
Authors: Vikas Singh; Rodrigo Mendirichaga; Ignacio Inglessis-Azuaje; Igor F Palacios; William W O'Neill Journal: Curr Treat Options Cardiovasc Med Date: 2018-04-23