TCT-191 Mechanical Circulatory Support Devices and Transcatheter Aortic Valve Replacement: A Multicenter experience

Introduction: Short-term use of Mechanical Circulatory Support (MCS) has the potential to benefit the patients undergoing Transcatheter Aortic Valve Replacement (TAVR) who may be high-risk or suffer complications. The present study was conducted to address the contemporary use of MCS in TAVR procedures. Methods: The study included a total of 1794 TAVR procedures in the years 2011-2012 from Nationwide Inpatient Sample (NIS) database. Use of MCS was identified using ICD-9-CM codes. The patients were divided based on use of MCS devices. The primary outcome of the study was in-hospital mortality and the secondary outcomes were complications, length of stay (LOS) and cost. Multi-variate simple logistic regression models were used to identify independent predictors of the outcomes. Results: Out of total 1794 TAVR procedures, 190 (10.6 %) utilized a MCS device (MCS group) and 1,604 (89.4%) did not (non-MCS group). The use of MCS devices with TAVR was associated with increase in the in-hospital mortality (14.9% vs. 3.5%, p<0.01) with same results obtained in multi-variate models. The rates of complications were significantly higher in MCS group so as the mean length of stay (11.8±0.8 vs. 8.1±0.2 days, p<0.01) and cost ($68,997±3,656 vs. $55,878±653, p=0.03). Conclusion: Use of MCS in TAVR predicts increase in-hospital mortality, complications, LOS and cost of care.

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TCT-572 Mechanical Circulatory Support Utilization in Transcatheter Aortic Valve Replacement in the United States

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2018.08.1763 ◽

2018 ◽

Vol 72 (13) ◽

pp. B229

Author(s):

Ahmad Alkhalil ◽

Richard Hajjar ◽

David Song ◽

Kajal Shah ◽

Homam Ibrahim ◽

...

Keyword(s):

United States ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Mechanical Circulatory Support ◽

The United States ◽

Circulatory Support ◽

Transcatheter Aortic Valve

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Abstract 12999: Correcting the Current: Modeling the Hemodynamic Impact of Transcatheter Aortic Valve Replacement in Multiple Valvular Heart Disease Precipitating Cardiogenic Shock

Circulation ◽

10.1161/circ.142.suppl_3.12999 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Michael I Brener ◽

Amisha Patel ◽

Torsten Vahl ◽

Nadira Hamid ◽

Melana Yuzefpolskaya ◽

...

Keyword(s):

Heart Disease ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Cardiogenic Shock ◽

Valve Replacement ◽

Valvular Heart Disease ◽

Transcatheter Aortic Valve Replacement ◽

Circulatory Support ◽

Ventricular Performance ◽

Transcatheter Aortic Valve

Introduction: Multiple valvular heart disease (mVHD) caused by mixed stenotic and regurgitant lesions involving at least two valves is a common condition which is poorly understood and challenging to manage. Herein, we simulate the hemodynamics of a patient with mVHD before and after transcatheter aortic valve replacement (TAVR) to better understand the physiology of this complex disease. Case: A 67-year-old man with celiac enteropathy presented to a local hospital with dyspnea, hypotension, and oliguria. Echocardiography revealed a dilated left ventricle (end-diastolic diameter [LVEDD] 6.7 cm) with an ejection fraction (EF) of 20% and multiple severe valvulopathies, including aortic stenosis (AS), aortic regurgitation (AR), and mitral regurgitation (MR). Right heart catheterization revealed a low cardiac index (1.76 L/min/m 2 ) and a high wedge pressure (36 mmHg) with V-waves exceeding 50 mmHg. The patient’s severe AR precluded mechanical circulatory support, so TAVR was emergently performed in the setting of worsening cardiogenic shock (CS) with a 29 mm self-expanding bioprosthesis via transfemoral access. Valve deployment was successfully guided by fluoroscopy and transthoracic echocardiography alone. CS resolved in the subsequent 48 hours, and at 3-month follow-up, his LV EF returned to 55% and LVEDD decreased to 4.4 cm. LV pressure-volume loops pre- and post-TAVR were generated using a cardiovascular physiology simulator (Fig. 1). TAVR’s correction of the patient’s severe AS and AR produced immediate energetic benefits, with pressure-volume area declining 13% and cardiac power output increasing 2.24-fold. Conclusions: This challenging case and the accompanying pressure-volume analysis affirms the feasibility of emergent TAVR in highly selected patients, the procedure’s ability to immediately improve ventricular performance, and the LV’s capacity to remodel when operating under more physiologic loading conditions.

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Use of left ventricular support devices during transcatheter aortic valve replacement and balloon aortic valvuloplasty: a single center experience

European Heart Journal ◽

10.1093/eurheartj/ehab724.1622 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S Mahmood ◽

D Gelovani ◽

P Nona ◽

A Lemor ◽

M Basir ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Left Ventricular ◽

Bleeding Complications ◽

Circulatory Support ◽

Balloon Aortic Valvuloplasty ◽

Transcatheter Aortic Valve ◽

Aortic Valvuloplasty

Abstract Background Transcatheter aortic valve replacement (TAVR) and balloon aortic valvuloplasty (BAV) are definitive and bridging therapies in patients with aortic stenosis. Data on utilization of mechanical circulatory support (MCS) in this population is scarce. This study sought to evaluate the clinical outcomes of the use of Impella (Abiomed, Danvers, MA) in patients undergoing TAVR or BAV at a tertiary-care center. Methods We reviewed all TAVRs and BAVs that required Impella from 2012 and 2020. Patient demographics, procedural outcomes, complications, and 30-day mortality were analyzed. Results A total of 1,965 TAVR and 715 BAV cases were performed in the study period. 30 TAVR and 94 BAV cases required an Impella. 65% of these cases were due to cardiogenic shock (CS) (100% of TAVR and 55% of BAV). 31% were performed in female patients. Transfemoral access was utilized in 98% of cases. Impella CP was used in 98% of cases, other types of MCS were used in 8.7% of cases. 32.2% of cases required MCS for more than 24 hours. In the TAVR population the indication for MCS was 46.6% profound hypotension post valve deployment requiring vasopressors, 16.6% cardiac arrest, 10% sustained ventricular arrhythmia, 10% cardiac tamponade [Office1] and 10% coronary occlusion. In the BAV group the indication was 44% high-risk PCI and 56% CS. The 30-day mortality in TAVR was 40% and 28% in BAV; from the BAV group in CS the mortality was 45%. VARC-2 vascular complications and bleeding complications were observed in 4.8% and 1.5%, respectively. 0.7% of the total cohort required conversion to open-heart surgery. Conclusions Impella support is required in a minority of TAVR or BAV cases. In those who require MCS with Impella for either BAV or TAVR, the total mortality remains high especially in those experiencing CS. FUNDunding Acknowledgement Type of funding sources: None.

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Outcomes of Emergency Transcatheter Aortic Valve Replacement

Journal of Interventional Cardiology ◽

10.1155/2019/7598581 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Hans Huang ◽

Christopher P. Kovach ◽

Sean Bell ◽

Mark Reisman ◽

Gabriel Aldea ◽

...

Keyword(s):

Heart Failure ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Decompensated Heart Failure ◽

Circulatory Support ◽

Transcatheter Aortic Valve

Objective. To identify outcomes of patients undergoing emergency transcatheter aortic valve replacement (TAVR) and determine predictors of in-hospital mortality. Background. Emergency TAVR has emerged as a viable treatment strategy for patients with decompensated severe aortic stenosis and/or regurgitation; however, data on patients undergoing emergency TAVR are limited. Methods. All emergency TAVR procedures were identified from a single tertiary academic center between January 2015 and August 2018. Results. 31 patients underwent emergency TAVR due to cardiogenic shock (26 patients), electrical instability with incessant ventricular tachycardia (2 patients), severe refractory angina (2 patients), and decompensated heart failure with hypoxemic respiratory failure requiring mechanical ventilation (1 patient). Mechanical circulatory support (MCS) was used in 16 (51.6%). MCS initiation occurred immediately prior to TAVR in 10 patients and placed post-TAVR in 6 patients. 6 patients died before hospital discharge (in-hospital mortality 19.4%). 1-year and 2-year survival rates were 61.0% and 55.9%, respectively. Univariate predictors of in-hospital mortality were preprocedural pulmonary artery pulsatility index (PAPi) ≤1.8 (66.7% vs. 20.0%, p=0.01), intraprocedural cardiopulmonary resuscitation (CPR) (83.3% vs 4.0%, p≤0.001), acute kidney injury post-TAVR (80.0% vs. 4.2%, p≤0.001), initiation of dialysis post-TAVR (60.0% vs. 4.2%, p≤0.001), and MCS initiation post-TAVR (50.0% vs. 12.0%, p=0.03). MCS initiation before TAVR was associated with improved survival compared with post-TAVR initiation. Conclusion. Emergency TAVR in extreme risk patients with acute decompensated heart failure or cardiogenic shock secondary to severe aortic valve disease is associated with high in-hospital mortality rates. Careful patient selection taking into account right heart function, assessed by PAPi, and early utilization of MCS may improve survival following emergency TAVR.

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