Katia Orvin1, Leor Perl1, Uri Landes1,2, Danny Dvir3, John George Webb2, Marie-Elisabeth Stelzmüller4, Wilfried Wisser4, Tamim Michael Nazif5, Isaac George5, Mizuki Miura6, Maurizio Taramasso6, Thomas Pilgrim7, Monika Fürholz7, Jan-Malte Sinning8, Georg Nickenig8, Chris Rumer3, Giuseppe Tarantini9, Giulia Masiero9, Matjas Bunc10, Peter Radsel10, Azeem Latib11, Faraj Kargoli11, Alfonso Ielasi12, Massimo Medda12, Luis Nombela-Franco13, Hana Vaknin-Assa1, Ran Kornowski1. 1. Department of Cardiology, Rabin Medical Center, Petach Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 2. Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada. 3. Department of Cardiology, University of Washington Medical Center, Seattle, Washington, USA. 4. Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria. 5. Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA. 6. Department of Cardiac Surgery, University Heart Center Zurich, Zurich, Switzerland. 7. Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland. 8. Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany. 9. Department of Cardiac, Vascular, Thoracic Sciences and Public Health, University of Padua, Padua, Italy. 10. Department for Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia. 11. Division of Cardiology, Montefiore Medical Center, New York, New York, USA. 12. Clinical and Interventional Cardiology Unit, Istututo Clinico S. Ambrogio, Milan, Italy. 13. Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain.
Abstract
OBJECTIVES: To evaluate the use and outcomes of percutaneous mechanical circulatory support (pMCS) utilized during transcatheter aortic valve implantation (TAVI) from high-volume centers. METHODS AND RESULTS: Our international multicenter registry including 13 high-volume TAVI centers with 87 patients (76.5 ± 11.8 years, 63.2% men) who underwent TAVI for severe aortic stenosis and required pMCS (75.9% VA-ECMO, 19.5% Impella CP, 4.6% TandemHeart) during the procedure (prior to TAVI 39.1%, emergent rescue 50.6%, following TAVI 10.3%). The procedures were considered high-risk, with 50.6% having severe left ventricular dysfunction, 24.1% biventricular dysfunction, and 32.2% severe pulmonary hypertension. In-hospital and 1-year mortality were 27.5% and 49.4%, respectively. Patients with prophylactic hemodynamic support had lower periprocedural mortality compared to patients with rescue insertion of pMCS (log rank = 0.013) and patients who did not undergo cardiopulmonary resuscitation during the TAVI procedure had better short and long term survival (log rank <0.001 and 0.015, respectively). CONCLUSIONS: Given the overall survival rate and low frequency of pMCS-related complications, our study results support the use of pMCS prophylactically or during the course of TAVI (bailout) in order to improve clinical outcomes in high-risk procedures or in case of acute life-threatening hemodynamic collapse.
OBJECTIVES: To evaluate the use and outcomes of percutaneous mechanical circulatory support (pMCS) utilized during transcatheter aortic valve implantation (TAVI) from high-volume centers. METHODS AND RESULTS: Our international multicenter registry including 13 high-volume TAVI centers with 87 patients (76.5 ± 11.8 years, 63.2% men) who underwent TAVI for severe aortic stenosis and required pMCS (75.9% VA-ECMO, 19.5% Impella CP, 4.6% TandemHeart) during the procedure (prior to TAVI 39.1%, emergent rescue 50.6%, following TAVI 10.3%). The procedures were considered high-risk, with 50.6% having severe left ventricular dysfunction, 24.1% biventricular dysfunction, and 32.2% severe pulmonary hypertension. In-hospital and 1-year mortality were 27.5% and 49.4%, respectively. Patients with prophylactic hemodynamic support had lower periprocedural mortality compared to patients with rescue insertion of pMCS (log rank = 0.013) and patients who did not undergo cardiopulmonary resuscitation during the TAVI procedure had better short and long term survival (log rank <0.001 and 0.015, respectively). CONCLUSIONS: Given the overall survival rate and low frequency of pMCS-related complications, our study results support the use of pMCS prophylactically or during the course of TAVI (bailout) in order to improve clinical outcomes in high-risk procedures or in case of acute life-threatening hemodynamic collapse.