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

Abstract

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.

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

“…Due to the improvements in device technology, technique, and success rates, TAVR has evolved into a relatively low‐risk procedure despite the high comorbidity and relative frailty of patients needing this procedure 18. As noted in a recent article, less than 5% of all TAVR procedures require conversion to open surgery, making this procedure both safe and feasible in high‐risk populations 19. However, in patients presenting with concomitant cardiogenic shock, TAVR is associated with nearly 33% 30‐day and 60% 1‐year mortality 20.…”

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

“…However, severe complications requiring sternotomy still occur in about 1–2.8% and are associated with an increase in 30‐day mortality of up to 45% . With decreasing complication rates, the necessity for a multidisciplinary heart team and stand‐by circulatory support has been challenged by some , while others have highlighted the importance . In this study, we observed a steep decline in the need of emergency vaECMO during a 6‐year period from 9.3% in 2010 to 0.9% in 2015, indicating a substantial reduction in life‐threatening complications with increasing experience and iteration of devices.…”

Percutaneous mechanical circulatory support from the collaborative multicenter Mechanical Unusual Support in TAVI (MUST) Registry

“…Moreover, with greater experience and better success rates, TAVI has become feasible and is increasingly used in very high-risk patients. 20 Proper preparation before dangerous procedures with maximal prophylactic support may assist in the success of the intervention and improve patient outcomes. On the other hand, pMCSs are expensive, not always available, and may be associated with inherent complications.…”

“…Yet, unpredicted complications may occur, and a backup strategy should be available to prevent imminent death during acute, life‐threatening hemodynamic collapse. Moreover, with greater experience and better success rates, TAVI has become feasible and is increasingly used in very high‐risk patients 20 . Proper preparation before dangerous procedures with maximal prophylactic support may assist in the success of the intervention and improve patient outcomes.…”