Predictors of Prolonged Hemodynamic Compromise After Valve Deployment During Transcatheter Aortic Valve Implantation

Iritakenishi, Takeshi; Kamibayashi, Takahiko; Torikai, Kei; Maeda, Koichi; Kuratani, Toru; Sawa, Yoshiki; Fujino, Yuji

doi:10.1053/j.jvca.2015.02.019

Cited by 7 publications

(8 citation statements)

References 29 publications

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“…As with any hypotensive period, RVP may have adverse clinical impact. However, even though RVP is routinely performed during the majority of TAVR procedures, current data on the clinical impact of RVP during TAVR are limited to small numbers of patients with surrogate end points 1, 2, 4, 7. Few studies have correlated RVP with a clinical end point.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Rapid Ventricular Pacing on Outcome After Transcatheter Aortic Valve Replacement

Fefer

Bogdan

Grossman

et al. 2018

JAHA

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BackgroundRapid ventricular pacing (RVP) is used commonly during transcatheter aortic valve replacement (TAVR). Little is known about the safety and clinical consequences of this step. The aim of this study was to assess the impact of RVP on immediate and long‐term clinical outcomes in a large cohort of non‐selected TAVR patients.Method and ResultsThe study included 412 consecutive patients undergoing TAVR with a mean age of 82±7 years, of which 47% were male. Patients were divided according to the number of RVPs during the TAVR procedure comparing patients undergoing no pacing (0), 1 to 2, and ≥3 pacing episodes (3+). Patients undergoing 3+ pacing episodes were significantly more likely to develop new atrial fibrillation (5.6% versus 7.3% versus 15%, respectively, for 0, 1–2, and 3+ groups, P=0.047), acute kidney injury (AKI) (18% versus 18% versus 28%, respectively, P<0.001), prolonged procedural hypotension (0%, 16%, and 25%, respectively; P<0.001), and suffered greater in‐hospital mortality (1.7%, 1.7%, and 6.5%, respectively, P=0.045), and 1‐year mortality (11.1%, 7.7%, and 18%, respectively, P=0.015). Multivariate Cox regression analysis indicated that acute kidney injury (OR 3.27 [1.763–6.09], P<0.001), euroSCORE II (OR 1.06 per unit [1.01–1.12], P=0.03), and 3+ pacing episodes (OR 2.35 [1.18–4.7], P=0.02) were the only independent predictors for 1‐year mortality.ConclusionsIn patients undergoing TAVR, multiple RVP episodes and prolonged RVP duration are associated with adverse outcomes including short‐ and long‐term mortality. Thus, operators should attempt to minimize the use of RVP, especially in patients who are at risk for post‐procedural acute kidney injury.

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Section: Discussionmentioning

confidence: 99%

“…Indeed, prior case reports and small‐scale studies have reported conflicting data on the hemodynamic effects and clinical impact of RVP during TAVR 1, 2, 3, 4. Thus the aim of the present study was to assess the clinical impact of RVP on immediate and long‐term outcomes in a large cohort of non‐selected TAVR patients.…”

Section: Introductionmentioning

confidence: 97%

Impact of Rapid Ventricular Pacing on Outcome After Transcatheter Aortic Valve Replacement

Fefer

Bogdan

Grossman

et al. 2018

JAHA

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“…In contrast, to this study, none of the patients in our current study needed CPB support. This may be due to our more liberal use of dobutamine for inotropic support in 60% of patients as compared to 40% receiving dopamine in the previous study [9]. Our patients could be considered to be suffering from even more Open Journal of Anesthesiology co-morbidities and a lower ejection fraction than the patients examined by Iritakeneshi et al Most of our patients (70%) were operated transapically as compared to 40% of patients in that other study.…”

Section: Discussionmentioning

confidence: 58%

“…It has been reported that low SvO 2 prior to RVP was associated with prolonged hemodynamic recovery immediately after RVP for valve-stent deployment [9]. In that study, three patients needed CPB support due to circulatory collapse, as they were unresponsive to hemodynamic support by drugs.…”

Section: Discussionmentioning

confidence: 87%

“…The SvO 2 reverted rapidly to the same level as before the application How to cite this paper: Musialowicz, T., Ellam, S., Valtola, A., Halonen, J. and Lahtinen, P. (2019) Mixed Venous Oxygen Saturation during the Transcatheter Aortic Valve Replacement-A Prospective Cohort Study. Open Journal of Anesthesiology,9,[140][141][142][143][144][145][146][147][148][149][150][151][152][153] of RVP (1 min), CO, and CI 10 min later. At the end of the operation SvO 2 values were at same level as before RVP and CO and CI were higher than before RVP.…”

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confidence: 99%

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Mixed Venous Oxygen Saturation during the Transcatheter Aortic Valve Replacement—A Prospective Cohort Study

Musialowicz¹,

Ellam²,

Valtola³

et al. 2019

OJAnes

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Purpose: Patients scheduled to undergo the transcatheter aortic valve replacement (TAVR) are usually octogenarians with severe co-morbidities and an increased risk of surgery-associated complications. The aim of this study was to determine the incidence of insufficient oxygen delivery as measured by mixed venous oxygen saturation (SvO 2 ) via invasive continuous cardiopulmonary monitoring and the low cardiac output syndrome (LCOS) in patients undergoing the TAVR procedure. The second objective was to examine how these hemodynamic measurements would change during critical events, such as rapid ventricular pacing (RVP) during this procedure. Methods: This prospective, observational study, examined twenty patients undergoing TAVR under general anesthesia. Hemodynamic variables, SvO 2 and the continuous cardiac output (CO) were assessed using pulmonary artery catheter (PAC) and a Vigilance ® monitor. Insufficient oxygen delivery was defined as a SvO 2 value under 58% and LCOS as a cardiac index (CI) under 2 L/min/m 2 . Total intravenous anesthesia and hemodynamic management protocol were standardized. RVP was induced twice during the procedure at a frequency of 180 -200/min. Predefined clinical endpoints were assessed during the procedure and hemodynamic values were analyzed before and after twelve critical events. Results: The data of twenty patients with a mean age of 80 ± 4 years and EuroSCORE 18 ± 10 were analyzed. Fourteen (70%) of the TAVR procedures were performed transapically, the other six (30%) transfemorally. The SvO 2 value under 58% (mean 54 ± 6) and the CI under 2 L/min/m 2 (mean 1.6 ± 0.2) were detected in 60% of patients (n = 12) before the use of RVP. All of these patients received perioperative inotropic medication and required norepinephrine infusion for maintenance of adequate blood pressure. The SvO 2 , CO and CI were significantly decreased after the use of RVP (P < 0.001 and P < 0.03). The SvO 2 reverted rapidly to the same level as before the application How to cite this paper: Musialowicz, T., Ellam, S., Valtola, A., Halonen, J. and Lahtinen, P. (2019) Mixed Venous Oxygen Saturation during the Transcatheter Aortic Valve Replacement-A Prospective Cohort Study. Open Journal of Anesthesiology,9,[140][141][142][143][144][145][146][147][148][149][150][151][152][153] of RVP (1 min), CO, and CI 10 min later. At the end of the operation SvO 2 values were at same level as before RVP and CO and CI were higher than before RVP. Conclusion: A high incidence of insufficient oxygen delivery and low cardiac output syndrome were detected in patients undergoing TAVR procedures. Nonetheless, all hemodynamic values returned rather rapidly to the same level as before the use of the RVP and were at the optimal level at the end of the procedure. According to the current study, the most hemodynamically hazardous steps during TAVR are the use of RVP sequences, the induction of anesthesia and the initiation of surgery.

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Anesthetic Management for Transcatheter Aortic Valve Implantation (TAVI)

Miles

Klein

2020

Evidence-Based Practice in Perioperative Cardiac Anesthesia and Surgery

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Predictors of Prolonged Hemodynamic Compromise After Valve Deployment During Transcatheter Aortic Valve Implantation

Cited by 7 publications

References 29 publications

Impact of Rapid Ventricular Pacing on Outcome After Transcatheter Aortic Valve Replacement

Impact of Rapid Ventricular Pacing on Outcome After Transcatheter Aortic Valve Replacement

Mixed Venous Oxygen Saturation during the Transcatheter Aortic Valve Replacement—A Prospective Cohort Study

Anesthetic Management for Transcatheter Aortic Valve Implantation (TAVI)

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