Elective or Emergency Use of Mechanical Circulatory Support Devices During Transcatheter Aortic Valve Replacement

Vikas Singh, Abdulla A. Damluji, Rodrigo Mendirichaga, Carlos E Alfonso, Claudia Martinez, Donald Williams, Alan W. Heldman, Eduardo De Marchena, William W. O'Neill, Mauricio G Cohen

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objective: Evaluate the use of mechanical circulatory support (MCS) devices in high-risk patients undergoing transcatheter aortic valve replacement (TAVR). Background: The use of MCS devices in elderly patients with multiple comorbidities undergoing TAVR is underexplored. Methods: All patients undergoing TAVR at a single tertiary academic center who required MCS during index procedure between 2008 and 2015 were included in a prospective database. Results: MCS was used in 9.4% (54/577) of all TAVRs (n = 52 Edwards Sapien and n = 2 CoreValves) of which 68.5% (n = 37) were used as part of a planned strategy, and 31.5% (n = 17) were used in emergency “bail-out” situations. IABP was the most commonly used device (87%) followed by Impella and ECMO (6% each). Among the MCS group, 22% required cardiopulmonary resuscitation during the procedure (n = 4 elective [11%] vs. n = 8 emergent [47%]) and 15% upgrade to a second device (Impella or CPB after IABP; n = 5 elective [14%] vs. n = 3 emergent [18%]). Median duration of support was 1-day. Device related complications were low (4%). In-hospital mortality in this extremely high-risk population was 24% (13/54) (11% [4/37] for elective cases and 53% [9/17] for emergency cases). Cardiogenic shock (50%) was the most common cause of in-hospital death. Cumulative all-cause 1-year mortality was 35% (19/54) (19% 97/370 for elective and 71% [12/17] for emergency cases). Conclusion: Emergent use of MCS during TAVR in extremely high-risk population is associated with high short and long-term mortality rates. Early identification of patients at risk for hemodynamic compromise may rationalize elective utilization of MCS during TAVR.

Original languageEnglish (US)
Pages (from-to)513-522
Number of pages10
JournalJournal of Interventional Cardiology
Volume29
Issue number5
DOIs
StatePublished - Oct 1 2016

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Emergencies
Equipment and Supplies
Cardiogenic Shock
Mortality
Self-Help Groups
Cardiopulmonary Resuscitation
Hospital Mortality
Population
Comorbidity
Hemodynamics
Transcatheter Aortic Valve Replacement
Databases

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Elective or Emergency Use of Mechanical Circulatory Support Devices During Transcatheter Aortic Valve Replacement. / Singh, Vikas; Damluji, Abdulla A.; Mendirichaga, Rodrigo; Alfonso, Carlos E; Martinez, Claudia; Williams, Donald; Heldman, Alan W.; De Marchena, Eduardo; O'Neill, William W.; Cohen, Mauricio G.

In: Journal of Interventional Cardiology, Vol. 29, No. 5, 01.10.2016, p. 513-522.

Research output: Contribution to journalArticle

Singh, Vikas ; Damluji, Abdulla A. ; Mendirichaga, Rodrigo ; Alfonso, Carlos E ; Martinez, Claudia ; Williams, Donald ; Heldman, Alan W. ; De Marchena, Eduardo ; O'Neill, William W. ; Cohen, Mauricio G. / Elective or Emergency Use of Mechanical Circulatory Support Devices During Transcatheter Aortic Valve Replacement. In: Journal of Interventional Cardiology. 2016 ; Vol. 29, No. 5. pp. 513-522.
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abstract = "Objective: Evaluate the use of mechanical circulatory support (MCS) devices in high-risk patients undergoing transcatheter aortic valve replacement (TAVR). Background: The use of MCS devices in elderly patients with multiple comorbidities undergoing TAVR is underexplored. Methods: All patients undergoing TAVR at a single tertiary academic center who required MCS during index procedure between 2008 and 2015 were included in a prospective database. Results: MCS was used in 9.4{\%} (54/577) of all TAVRs (n = 52 Edwards Sapien and n = 2 CoreValves) of which 68.5{\%} (n = 37) were used as part of a planned strategy, and 31.5{\%} (n = 17) were used in emergency “bail-out” situations. IABP was the most commonly used device (87{\%}) followed by Impella and ECMO (6{\%} each). Among the MCS group, 22{\%} required cardiopulmonary resuscitation during the procedure (n = 4 elective [11{\%}] vs. n = 8 emergent [47{\%}]) and 15{\%} upgrade to a second device (Impella or CPB after IABP; n = 5 elective [14{\%}] vs. n = 3 emergent [18{\%}]). Median duration of support was 1-day. Device related complications were low (4{\%}). In-hospital mortality in this extremely high-risk population was 24{\%} (13/54) (11{\%} [4/37] for elective cases and 53{\%} [9/17] for emergency cases). Cardiogenic shock (50{\%}) was the most common cause of in-hospital death. Cumulative all-cause 1-year mortality was 35{\%} (19/54) (19{\%} 97/370 for elective and 71{\%} [12/17] for emergency cases). Conclusion: Emergent use of MCS during TAVR in extremely high-risk population is associated with high short and long-term mortality rates. Early identification of patients at risk for hemodynamic compromise may rationalize elective utilization of MCS during TAVR.",
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AU - Singh, Vikas

AU - Damluji, Abdulla A.

AU - Mendirichaga, Rodrigo

AU - Alfonso, Carlos E

AU - Martinez, Claudia

AU - Williams, Donald

AU - Heldman, Alan W.

AU - De Marchena, Eduardo

AU - O'Neill, William W.

AU - Cohen, Mauricio G

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N2 - Objective: Evaluate the use of mechanical circulatory support (MCS) devices in high-risk patients undergoing transcatheter aortic valve replacement (TAVR). Background: The use of MCS devices in elderly patients with multiple comorbidities undergoing TAVR is underexplored. Methods: All patients undergoing TAVR at a single tertiary academic center who required MCS during index procedure between 2008 and 2015 were included in a prospective database. Results: MCS was used in 9.4% (54/577) of all TAVRs (n = 52 Edwards Sapien and n = 2 CoreValves) of which 68.5% (n = 37) were used as part of a planned strategy, and 31.5% (n = 17) were used in emergency “bail-out” situations. IABP was the most commonly used device (87%) followed by Impella and ECMO (6% each). Among the MCS group, 22% required cardiopulmonary resuscitation during the procedure (n = 4 elective [11%] vs. n = 8 emergent [47%]) and 15% upgrade to a second device (Impella or CPB after IABP; n = 5 elective [14%] vs. n = 3 emergent [18%]). Median duration of support was 1-day. Device related complications were low (4%). In-hospital mortality in this extremely high-risk population was 24% (13/54) (11% [4/37] for elective cases and 53% [9/17] for emergency cases). Cardiogenic shock (50%) was the most common cause of in-hospital death. Cumulative all-cause 1-year mortality was 35% (19/54) (19% 97/370 for elective and 71% [12/17] for emergency cases). Conclusion: Emergent use of MCS during TAVR in extremely high-risk population is associated with high short and long-term mortality rates. Early identification of patients at risk for hemodynamic compromise may rationalize elective utilization of MCS during TAVR.

AB - Objective: Evaluate the use of mechanical circulatory support (MCS) devices in high-risk patients undergoing transcatheter aortic valve replacement (TAVR). Background: The use of MCS devices in elderly patients with multiple comorbidities undergoing TAVR is underexplored. Methods: All patients undergoing TAVR at a single tertiary academic center who required MCS during index procedure between 2008 and 2015 were included in a prospective database. Results: MCS was used in 9.4% (54/577) of all TAVRs (n = 52 Edwards Sapien and n = 2 CoreValves) of which 68.5% (n = 37) were used as part of a planned strategy, and 31.5% (n = 17) were used in emergency “bail-out” situations. IABP was the most commonly used device (87%) followed by Impella and ECMO (6% each). Among the MCS group, 22% required cardiopulmonary resuscitation during the procedure (n = 4 elective [11%] vs. n = 8 emergent [47%]) and 15% upgrade to a second device (Impella or CPB after IABP; n = 5 elective [14%] vs. n = 3 emergent [18%]). Median duration of support was 1-day. Device related complications were low (4%). In-hospital mortality in this extremely high-risk population was 24% (13/54) (11% [4/37] for elective cases and 53% [9/17] for emergency cases). Cardiogenic shock (50%) was the most common cause of in-hospital death. Cumulative all-cause 1-year mortality was 35% (19/54) (19% 97/370 for elective and 71% [12/17] for emergency cases). Conclusion: Emergent use of MCS during TAVR in extremely high-risk population is associated with high short and long-term mortality rates. Early identification of patients at risk for hemodynamic compromise may rationalize elective utilization of MCS during TAVR.

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