Outcomes of hemodynamic support with Impella in very high-risk patients undergoing balloon aortic valvuloplasty: Results from the Global cVAD Registry

Vikas Singh, Pradeep K. Yadav, Marvin H. Eng, Francisco Yuri Macedo, Guilherme V. Silva, Rodrigo Mendirichaga, Amit P. Badiye, Rahul Sakhuja, Sammy Elmariah, Ignacio Inglessis, Carlos E Alfonso, Theodore L. Schreiber, Mauricio G Cohen, Igor Palacios, William W. O'Neill

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Reports on the role of hemodynamic support devices in patients with severe aortic stenosis (AS) and left ventricular (LV) dysfunction undergoing balloon aortic valvuloplasty (BAV) are limited. Methods: Patients were identified from the cVAD registry, an ongoing multicenter voluntary registry at selected sites in North America that have used Impella in >. 10 patients. Results: A total of 116 patients with AS who underwent BAV with Impella support were identified. Mean age was 80.41. ±. 9.03. years and most patients were male. Mean STS score was 18.77%. ±. 18.32, LVEF was 27.14%. ±. 16.07, and 42% underwent concomitant PCI. In most cases Impella was placed electively prior to BAV, whereas 26.7% were placed as an emergency. The two groups had similar baseline characteristics except for higher prevalence of CAD and lower LVEF in the elective group, and higher STS score in the emergency group. Elective strategy was associated higher 1-year survival compared to emergency placement (56% vs. 29.2%, p = 0.003). One-year survival was higher when BAV was used as a bridge to definitive therapy as opposed to palliative treatment (90% vs. 28%, p. <. 0.001). On multivariate analysis, STS score and aim of BAV (bridge to definitive therapy vs. palliative indication) were independent predictors of mortality. Conclusion: In this large cohort of patients with AS and severe LV dysfunction undergoing BAV, our results demonstrates feasibility and promising long-term outcomes using elective Impella support with the intention to bridge to a definitive therapy.

Original languageEnglish (US)
JournalInternational Journal of Cardiology
DOIs
StateAccepted/In press - Mar 3 2017

Fingerprint

Balloon Valvuloplasty
Registries
Hemodynamics
Aortic Valve Stenosis
Emergencies
Left Ventricular Dysfunction
Survival
North America
Palliative Care
Therapeutics
Multivariate Analysis
Equipment and Supplies
Mortality

Keywords

  • Aortic stenosis
  • Balloon aortic valvuloplasty
  • Impella
  • Left ventricular dysfunction

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes of hemodynamic support with Impella in very high-risk patients undergoing balloon aortic valvuloplasty : Results from the Global cVAD Registry. / Singh, Vikas; Yadav, Pradeep K.; Eng, Marvin H.; Macedo, Francisco Yuri; Silva, Guilherme V.; Mendirichaga, Rodrigo; Badiye, Amit P.; Sakhuja, Rahul; Elmariah, Sammy; Inglessis, Ignacio; Alfonso, Carlos E; Schreiber, Theodore L.; Cohen, Mauricio G; Palacios, Igor; O'Neill, William W.

In: International Journal of Cardiology, 03.03.2017.

Research output: Contribution to journalArticle

Singh, V, Yadav, PK, Eng, MH, Macedo, FY, Silva, GV, Mendirichaga, R, Badiye, AP, Sakhuja, R, Elmariah, S, Inglessis, I, Alfonso, CE, Schreiber, TL, Cohen, MG, Palacios, I & O'Neill, WW 2017, 'Outcomes of hemodynamic support with Impella in very high-risk patients undergoing balloon aortic valvuloplasty: Results from the Global cVAD Registry', International Journal of Cardiology. https://doi.org/10.1016/j.ijcard.2017.03.071
Singh, Vikas ; Yadav, Pradeep K. ; Eng, Marvin H. ; Macedo, Francisco Yuri ; Silva, Guilherme V. ; Mendirichaga, Rodrigo ; Badiye, Amit P. ; Sakhuja, Rahul ; Elmariah, Sammy ; Inglessis, Ignacio ; Alfonso, Carlos E ; Schreiber, Theodore L. ; Cohen, Mauricio G ; Palacios, Igor ; O'Neill, William W. / Outcomes of hemodynamic support with Impella in very high-risk patients undergoing balloon aortic valvuloplasty : Results from the Global cVAD Registry. In: International Journal of Cardiology. 2017.
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abstract = "Background: Reports on the role of hemodynamic support devices in patients with severe aortic stenosis (AS) and left ventricular (LV) dysfunction undergoing balloon aortic valvuloplasty (BAV) are limited. Methods: Patients were identified from the cVAD registry, an ongoing multicenter voluntary registry at selected sites in North America that have used Impella in >. 10 patients. Results: A total of 116 patients with AS who underwent BAV with Impella support were identified. Mean age was 80.41. ±. 9.03. years and most patients were male. Mean STS score was 18.77{\%}. ±. 18.32, LVEF was 27.14{\%}. ±. 16.07, and 42{\%} underwent concomitant PCI. In most cases Impella was placed electively prior to BAV, whereas 26.7{\%} were placed as an emergency. The two groups had similar baseline characteristics except for higher prevalence of CAD and lower LVEF in the elective group, and higher STS score in the emergency group. Elective strategy was associated higher 1-year survival compared to emergency placement (56{\%} vs. 29.2{\%}, p = 0.003). One-year survival was higher when BAV was used as a bridge to definitive therapy as opposed to palliative treatment (90{\%} vs. 28{\%}, p. <. 0.001). On multivariate analysis, STS score and aim of BAV (bridge to definitive therapy vs. palliative indication) were independent predictors of mortality. Conclusion: In this large cohort of patients with AS and severe LV dysfunction undergoing BAV, our results demonstrates feasibility and promising long-term outcomes using elective Impella support with the intention to bridge to a definitive therapy.",
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T2 - Results from the Global cVAD Registry

AU - Singh, Vikas

AU - Yadav, Pradeep K.

AU - Eng, Marvin H.

AU - Macedo, Francisco Yuri

AU - Silva, Guilherme V.

AU - Mendirichaga, Rodrigo

AU - Badiye, Amit P.

AU - Sakhuja, Rahul

AU - Elmariah, Sammy

AU - Inglessis, Ignacio

AU - Alfonso, Carlos E

AU - Schreiber, Theodore L.

AU - Cohen, Mauricio G

AU - Palacios, Igor

AU - O'Neill, William W.

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N2 - Background: Reports on the role of hemodynamic support devices in patients with severe aortic stenosis (AS) and left ventricular (LV) dysfunction undergoing balloon aortic valvuloplasty (BAV) are limited. Methods: Patients were identified from the cVAD registry, an ongoing multicenter voluntary registry at selected sites in North America that have used Impella in >. 10 patients. Results: A total of 116 patients with AS who underwent BAV with Impella support were identified. Mean age was 80.41. ±. 9.03. years and most patients were male. Mean STS score was 18.77%. ±. 18.32, LVEF was 27.14%. ±. 16.07, and 42% underwent concomitant PCI. In most cases Impella was placed electively prior to BAV, whereas 26.7% were placed as an emergency. The two groups had similar baseline characteristics except for higher prevalence of CAD and lower LVEF in the elective group, and higher STS score in the emergency group. Elective strategy was associated higher 1-year survival compared to emergency placement (56% vs. 29.2%, p = 0.003). One-year survival was higher when BAV was used as a bridge to definitive therapy as opposed to palliative treatment (90% vs. 28%, p. <. 0.001). On multivariate analysis, STS score and aim of BAV (bridge to definitive therapy vs. palliative indication) were independent predictors of mortality. Conclusion: In this large cohort of patients with AS and severe LV dysfunction undergoing BAV, our results demonstrates feasibility and promising long-term outcomes using elective Impella support with the intention to bridge to a definitive therapy.

AB - Background: Reports on the role of hemodynamic support devices in patients with severe aortic stenosis (AS) and left ventricular (LV) dysfunction undergoing balloon aortic valvuloplasty (BAV) are limited. Methods: Patients were identified from the cVAD registry, an ongoing multicenter voluntary registry at selected sites in North America that have used Impella in >. 10 patients. Results: A total of 116 patients with AS who underwent BAV with Impella support were identified. Mean age was 80.41. ±. 9.03. years and most patients were male. Mean STS score was 18.77%. ±. 18.32, LVEF was 27.14%. ±. 16.07, and 42% underwent concomitant PCI. In most cases Impella was placed electively prior to BAV, whereas 26.7% were placed as an emergency. The two groups had similar baseline characteristics except for higher prevalence of CAD and lower LVEF in the elective group, and higher STS score in the emergency group. Elective strategy was associated higher 1-year survival compared to emergency placement (56% vs. 29.2%, p = 0.003). One-year survival was higher when BAV was used as a bridge to definitive therapy as opposed to palliative treatment (90% vs. 28%, p. <. 0.001). On multivariate analysis, STS score and aim of BAV (bridge to definitive therapy vs. palliative indication) were independent predictors of mortality. Conclusion: In this large cohort of patients with AS and severe LV dysfunction undergoing BAV, our results demonstrates feasibility and promising long-term outcomes using elective Impella support with the intention to bridge to a definitive therapy.

KW - Aortic stenosis

KW - Balloon aortic valvuloplasty

KW - Impella

KW - Left ventricular dysfunction

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