Extracorporeal Membrane Oxygenation for Very High-risk Transcatheter Aortic Valve Implantation

Seco, Michael; Forrest, Paul; Jackson, Simon; Martínez, Gonzalo; Andvik, Sarah; Bannon, Paul G.; Ng, M.; Fraser, John F.; Wilson, Michael K.; Vallely, Michael P.

doi:10.1016/j.hlc.2014.05.006

Cited by 49 publications

(28 citation statements)

References 14 publications

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“…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%

“…Currently, there is limited evidence on the prophylactic use of VA‐ECMO in critically ill patients needing a TAVR procedure. As noted in this article, only 1 out of 9 studies defined a high‐risk cohort for preprocedural VA‐ECMO use 15. Patients with pulmonary hypertension and biventricular failure would conceivably benefit from prophylactic VA‐ECMO; however this high‐risk cohort needs to be better defined to optimize the clinical outcomes 17.…”

Section: Discussionmentioning

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: Discussionmentioning

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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“…A study of 100 trans-catheter aortic valve implantation (TAVI) patients, reported that anticipation for ECMO and institution of this mode of support prophylactically in the “high-risk” category on the EuroSCORE scale would potentially prevent the need for salvage VA ECMO, in a less optimal and controlled clinical setting, and carry better outcomes. In this study all-cause mortality occurred in none of the high-risk patients undergoing prophylactic VA ECMO (although p > 0.05) [37]. …”

Section: Discussionmentioning

confidence: 99%

Extra-corporeal membrane oxygenation for refractory cardiogenic shock after adult cardiac surgery: a systematic review and meta-analysis

Khorsandi

Dougherty

Bouamra

et al. 2017

J Cardiothorac Surg

163

120

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BackgroundPostcardiotomy cardiogenic shock (PCCS) refractory to inotropic support and intra-aortic balloon pump (IABP) occurs rarely but is almost universally fatal without mechanical circulatory support. In this systematic review and meta-analysis we looked at the evidence behind the use of veno-arterial extra-corporeal membrane oxygenation (VA ECMO) in refractory PCCS from a patient survival rate and determinants of outcome viewpoint.MethodsA systematic review was performed in January 2017 using PubMed (with no defined time period) using the keywords “postcardiotomy”, “cardiogenic shock”, “extracorporeal membrane oxygenation” and “cardiac surgery”. We excluded papers pertaining to ECMO following paediatric cardiac surgery, medical causes of cardiogenic shock, as well as case reports, review articles, expert opinions, and letters to the editor. Once the studies were collated, a meta-analysis was performed on the proportion of survivors in those papers that met the inclusion criteria. Meta-regression was performed for the most commonly reported adverse prognostic indicators (API).ResultsWe identified 24 studies and a cumulative pool of 1926 patients from 1992 to 2016. We tabulated the demographic data, including the strengths and weaknesses for each of the studies, outcomes of VA ECMO for refractory PCCS, complications, and APIs. All the studies were retrospective cohort studies. Meta-analysis of the moderately heterogeneous data (95% CI 0.29 to 0.34, p < 0.01, I 2 = 60%) revealed overall survival rate to hospital discharge of 30.8%. Some of the commonly reported APIs were advanced age (>70 years, 95% CI −0.057 to 0.001, P = 0.058), and long ECMO support (95% CI −0.068 to 0.166, P = 0.412). Postoperative renal failure, high EuroSCORE (>20%), diabetes mellitus, obesity, rising lactate whilst on ECMO, gastrointestinal complications had also been reported.ConclusionHaemodynamic support with VA ECMO provides a survival benefit with reasonable intermediate and long-term outcomes. Many studies had reported advanced age, renal failure and prolonged VA ECMO support as the most likely APIs for VA ECMO in PCCS. EuroSCORE can be utilized to anticipate the need for prophylactic perioperative VA ECMO in the high-risk category. APIs can be used to aid decision-making regarding both the institution and weaning of ECMO for refractory PCCS.

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“…Finally, the observation that urgent conversion to surgery especially in high risk patients has worse outcome when is performed by sternotomy, supports the hypothesis that what we really need during a TAVR procedure is a left ventricular assist device for transient hemodynamic support, or a vascular surgeon for treating the possible vascular complications, and not necessarily a heart lung machine . The presence of left ventricular assist device instead of having a group of experts waiting as a safety net for a possible complication could possible decrease the overall cost of the process and could lead to proper and more rational resource utilization.…”

Section: Discussionmentioning

confidence: 69%

The requirement of extracorporeal circulation system for transluminal aortic valve replacement: Do we really need it in the catheterization laboratory?

Toutouzas

Synetos

Latsios

et al. 2015

Cathet Cardio Intervent

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Transcatheter aortic valve replacement (TAVR) is the mainstay for treating high-risk patients with aortic stenosis. As the TAVR procedures worldwide keep increasing, it is inevitable that more issues and complications will arise. Such a complication that merits attention is the conversion of TAVR into open-heart surgery and the necessity this complication creates to have an extracorporeal circulation system in the catheterization laboratory. This review contains an analysis of all major randomized trials and registries on the number and cause of TAVR procedures that ended up in open-heart surgery and presents data to challenge the prerequisite of extracorporeal circulation system in the cath laboratory. © 2015 Wiley Periodicals, Inc.

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Extracorporeal Membrane Oxygenation for Very High-risk Transcatheter Aortic Valve Implantation

Abstract: Background: Transcatheter aortic valve implantation (TAVI) can cause profound haemodynamic

Cited by 49 publications

References 14 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

Extra-corporeal membrane oxygenation for refractory cardiogenic shock after adult cardiac surgery: a systematic review and meta-analysis

The requirement of extracorporeal circulation system for transluminal aortic valve replacement: Do we really need it in the catheterization laboratory?

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