Cardiopulmonary bypass and intra‐aortic balloon pump use is associated with higher short and long term mortality after transcatheter aortic valve replacement: A PARTNER trial substudy

Shreenivas, Satya; Lilly, Scott; Szeto, Wilson Y.; Desai, Nimesh D.; Anwaruddin, Saif; Bavaria, Joseph E.; Hudock, Kristin; Thourani, Vinod H.; Makkar, Raj; Pichard, Augusto D.; Webb, John G.; Dewey, Todd M.; Kapadia, Samir; Suri, Rakesh M.; Xu, Ke; Leon, Martin B.; Herrmann, Howard C.

doi:10.1002/ccd.25776

Cited by 28 publications

(22 citation statements)

References 11 publications

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“…Where reported, the Edwards SAPIEN transcatheter heart valve was the most frequently used. This was the only valve in the PARTNER (Placement of Aortic Transcatheter Valves) trial, which contributed the most patients to this systematic review 8. As noted in Table 2, a majority (≥67%) of the TAVR procedures were performed by a transfemoral approach, except in the study by Uehara et al,17 in which only 14% were performed transfemorally.…”

Section: Resultsmentioning

confidence: 99%

“…Of those, 9 studies representing a total of 5191 patients met the inclusion criteria (Figure and Table 1). 8, 10, 11, 12, 13, 14, 15, 16, 17 All studies except the study by Seco et al15 were retrospective studies of institutional or national databases. All studies were published from 2012 to 2017, with 7 out of 9 studies published from the United States and Europe.…”

Section: Resultsmentioning

confidence: 99%

“…The substudy of the PARTNER trial registry by Shreenivas et al was the largest study, contributing 109/203 (53.7%) patients, all of whom needed CPB 8. Commonly noted indications for CPB/VA‐ECMO included left ventricular (LV) or aortic annular rupture, rapid hemodynamic deterioration, severe aortic regurgitation, cardiac arrest from ventricular tachycardia or fibrillation, and obstruction of the left main coronary artery 8, 10, 11, 12, 13, 14, 15, 16, 17. The definition of hemodynamic deterioration varied across studies and included low cardiac output, need for high‐dose vasopressors and inotropes, prolonged pacing sequence, and severe LV dysfunction on echocardiography.…”

Section: Resultsmentioning

confidence: 99%

“…In a retrospective review of the PARTNER registry, Shreenivas et al demonstrated that, regardless of an emergent versus planned strategy, CPB was associated with nearly 2‐fold higher mortality 8. The Society of Thoracic Surgeons Predicted Risk of Mortality and Logistic European System for Cardiac Operative Risk Evaluation Scores have shown poor calibration for predicting MCS use, and have advocated for further research into optimal patient, procedural, and device factors to develop individualized risk scores 8. Neurological complications in TAVR have been receiving increasing attention in recent years due to their long‐term consequences.…”

Section: Discussionmentioning

confidence: 99%

“…There have been multiple studies evaluating unselected MCS devices in the perioperative management of TAVR patients 7. Despite the concomitant use of both TAVR and cardiorespiratory support using the cardiopulmonary bypass (CPB) machine or the venoarterial extracorporeal membrane oxygenation (VA‐ECMO) technologies over the past decade, there are limited data on the indications, procedural characteristics, complications, and outcomes of these patients 8. In this systematic review we sought to analyze the clinical profile, indications, complications, device parameters, and mortality outcomes in TAVR patients needing CPB/VA‐ECMO.…”

Section: Introductionmentioning

confidence: 99%

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Periprocedural Cardiopulmonary Bypass or Venoarterial Extracorporeal Membrane Oxygenation During Transcatheter Aortic Valve Replacement: A Systematic Review

Vallabhajosyula

Patlolla

Sandhyavenu

et al. 2018

JAHA

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BackgroundThere are limited data on the use of venoarterial extracorporeal membrane oxygenation (VA‐ECMO) or cardiopulmonary bypass (CPB) to provide hemodynamic support periprocedurally during transcatheter aortic valve replacement. This study sought to evaluate patients receiving transcatheter aortic valve replacement with concomitant use of CPB/VA‐ECMO.Methods and ResultsWe systematically reviewed the published literature from 2000 to 2018 for studies evaluating adult patients requiring CPB/VA‐ECMO periprocedurally during transcatheter aortic valve replacement. Studies reporting short‐term and long‐term mortality were included. Given the significant methodological and statistical differences between published studies, meta‐analysis of the association of CPB/VA‐ECMO with mortality was not performed. Of the 537 studies identified, 9 studies representing 5191 patients met our inclusion criteria. Median ages were between 75 and 87 years with 33% to 75% male patients. Where reported, the Edwards SAPIEN™ transcatheter heart valve was the most frequently used. A total of 203 (3.9%) patients received periprocedural hemodynamic support with CPB/VA‐ECMO. Common indications for CPB/VA‐ECMO included left ventricular or aortic annular rupture, rapid hemodynamic deterioration, aortic regurgitation, cardiac arrest, and left main coronary artery obstruction. The use of CPB/VA‐ECMO was predominantly an emergent strategy and was used for durations of 1 to 2 hours. Short‐term mortality (in‐hospital and 30‐day) was 29.8%, and 1‐year mortality was 52.4%. Major complications such as bleeding, vascular injury, tamponade, stroke, and renal failure were noted in 10% to 50% of patients.Conclusions CPB/VA‐ECMO was used in 4% in the early experience of patients undergoing transcatheter aortic valve replacement, most commonly for periprocedural complications. There are limited data on preprocedural planned use of VA‐ECMO, and the characteristics of this population remain poorly defined.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Periprocedural Cardiopulmonary Bypass or Venoarterial Extracorporeal Membrane Oxygenation During Transcatheter Aortic Valve Replacement: A Systematic Review

Vallabhajosyula

Patlolla

Sandhyavenu

et al. 2018

JAHA

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Emergency extracorporeal membrane oxygenation in transcatheter aortic valve implantation: A two‐center experience of incidence, outcome and temporal trends from 2010 to 2015

Trenkwalder

Pellegrini

Holzamer

et al. 2017

Cathet Cardio Intervent

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Impact of COPD on outcomes in hospitalized patients treated with transcatheter aortic valve implantation or surgical aortic valve replacement in Spain

Miguel‐Díez

López‐de‐Andrés

Hernández-Barrera

et al. 2019

Cathet Cardio Intervent

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Objectives: To describe the use of transcatheter aortic valve implantation (TAVI) and conventional surgery (SAVR) among hospitalized patients with and without COPD, to compare the in-hospital mortality (IHM), length of hospital stay (LOHS) and cost between patients with COPD undergoing TAVI and SAVR and to identify factors associated to IHM among these patients.Background: TAVI would be expected to be less invasive and safer than SAVR among COPD patients. Methods:We analyzed patients whose medical procedures included TAVI and SAVR included in the Spanish National Hospital Discharge Database, 2014-2015. We stratified analysis by COPD status. Propensity score matching (1:2) was performed to assess the outcomes of TAVI vs. SAVR among COPD patients.Results: We identified 2,141 and 16,013 patients who underwent TAVI (27.60% with COPD) and SAVR (19.31% with COPD) respectively. For TAVI, we found no differences in IHM according to COPD status. Patients undergoing SAVR and suffering COPD had higher IHM than patients without COPD (adj.OR 1.32; 95%CI 1.10-1.58). After propensity score matching, IHM (8.35% vs. 5.83%, p = .040) and LOHS (18.62 days vs. 13.62; p < .001) were higher in COPD patients who underwent SAVR than those who underwent TAVI.Conclusions: COPD patients undergoing TAVI did not have a worse prognosis compared to non-COPD patients during hospitalization. However, for SAVR, patients with COPD had significantly higher mortality than patients without this condition. COPD patients who underwent SAVR had higher IHM and LOHS than propensity score matched TAVI patients. K E Y W O R D S aortic valve disease, epidemiology, transcatheter valve implantation

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Cardiopulmonary bypass and intra‐aortic balloon pump use is associated with higher short and long term mortality after transcatheter aortic valve replacement: A PARTNER trial substudy

Abstract: 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.

Cited by 28 publications

References 11 publications

Periprocedural Cardiopulmonary Bypass or Venoarterial Extracorporeal Membrane Oxygenation During Transcatheter Aortic Valve Replacement: A Systematic Review

Periprocedural Cardiopulmonary Bypass or Venoarterial Extracorporeal Membrane Oxygenation During Transcatheter Aortic Valve Replacement: A Systematic Review

Emergency extracorporeal membrane oxygenation in transcatheter aortic valve implantation: A two‐center experience of incidence, outcome and temporal trends from 2010 to 2015

Impact of COPD on outcomes in hospitalized patients treated with transcatheter aortic valve implantation or surgical aortic valve replacement in Spain

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