Use of extracorporeal membranous oxygenator in transcatheter aortic valve replacement

Abstract

The superiority of transcatheter aortic valve replacement (TAVR) compared with medical therapy for patients with aortic stenosis (AS) who are not suitable candidates for surgery had been proven. Cardiopulmonary bypass (CPB) is rarely used in TAVR. Reports of early use of extracorporeal membranous oxygenator (ECMO) have promising outcomes. ECMO offers the option of cardiac support rescue in case of intraoperative hemodynamic instability and can be instituted in advance when hemodynamic instability is expected. Here we review the English literature about the use of ECMO in TAVR procedures, and discuss the indications and rationale for its use as well as its advantages.

Preoperative Venoarterial Extracorporeal Membrane Oxygenation Slashes Risk Score in Advanced Structural Heart Disease

“…Current research focuses on development of alternative, endovascular treatments for inoperable patients. However, outcomes of endovascular procedures for structural heart disease are also predicted by STS PROM score and have poor outcomes in moribund patients [12][13][14][15][16]. Transcatheter aortic valve replacement (TAVR) in the setting of cardiogenic shock has a high procedural (20% to 30%), and 1 year (64% to 83%) mortality [12,16].…”

“…There are case reports of successful aortic [34] and mitral [35] interventions following stabilization with VA ECMO. Additionally, very short courses of intraprocedural ECMO has allowed successful TAVR in technically complicated cases, patients with intraoperative hemodynamic instability, or chronic heart failure [13,16,36,37]. It remains unclear whether the best approach to near-death, shock, and heart failure patients with structural heart disease will be endovascular surgery, preoperative VA ECMO, or both.…”

“…Mechanical circulatory support for postcardiotomy shock carries a mortality ranging from 40% to 75% [8][9][10][11]. Interventional therapies for structural heart disease afford therapeutic options for high-risk patients but have poor outcomes when done in the setting of cardiogenic shock or multisystem organ failure [12][13][14]. Transcatheter aortic valve replacement requiring intraprocedural mechanical circulatory support (MCS) is associated with significant morbidity and a 17% to 66% operative mortality [13,15,16].…”

Mechanical circulatory support in patients with severe aortic stenosis and left ventricular dysfunction undergoing percutaneous coronary intervention

“…15 The utility of various MCS in patients with severe AS undergoing planned or rescue PCI, balloon aortic valvuloplasty (BAV), or TAVR has been demonstrated. 9,[22][23][24][25][26][27] However, no comparative effectiveness, safety, or cost data between these MCS is available in the literature.…”

Anesthetic management for a patient with aortic stenosis who underwent transcatheter aortic valve implantation after introduction of percutaneous cardiopulmonary support

“…To maintain the patient's blood pressure, we used a high dose of inotropic agents. There have been reports using supplementary circulation such as PCPS at the time of a sudden change in preventive or intraoperative disorder [3][4][5][6], but we could not identify any report describing the introduction of PCPS after a sudden change in the condition of a patient with AS and the urgent implementation of TAVI. We believe that the emergent TAVI following PCPS is rare and that most Japanese anesthesiologists are not familiar with this type of perioperative management.…”