Extracorporeal membrane oxygenation for very high-risk transcatheter aortic valve implantation

Seco, Michael, Forrest, Paul, Jackson, Simon A., Martinez, Gonzalo, Andvik, Sarah, Bannon, Paul G., Ng, Martin, Fraser, John F., Wilson, Michael K. and Vallely, Michael P. (2014) Extracorporeal membrane oxygenation for very high-risk transcatheter aortic valve implantation. Heart Lung and Circulation, 23 10: 957-962. doi:10.1016/j.hlc.2014.05.006

Attached Files (Some files may be inaccessible until you login with your UQ eSpace credentials)
Name Description MIMEType Size Downloads
UQ342644_OA.pdf Full text (open access) application/pdf 174.91KB 0

Author Seco, Michael
Forrest, Paul
Jackson, Simon A.
Martinez, Gonzalo
Andvik, Sarah
Bannon, Paul G.
Ng, Martin
Fraser, John F.
Wilson, Michael K.
Vallely, Michael P.
Title Extracorporeal membrane oxygenation for very high-risk transcatheter aortic valve implantation
Journal name Heart Lung and Circulation   Check publisher's open access policy
ISSN 1443-9506
1444-2892
Publication date 2014-10-01
Year available 2014
Sub-type Article (original research)
DOI 10.1016/j.hlc.2014.05.006
Open Access Status Not yet assessed
Volume 23
Issue 10
Start page 957
End page 962
Total pages 6
Place of publication Chatswood, NSW, Australia
Publisher Elsevier Australia
Language eng
Subject 2740 Pulmonary and Respiratory Medicine
2705 Cardiology and Cardiovascular Medicine
Abstract Background Transcatheter aortic valve implantation (TAVI) can cause profound haemodynamic perturbation in the peri-operative period. Veno-arterial extracorporeal membrane oxygenation (ECMO) can be used to provide cardiorespiratory support during this time, either prophylactically or emergently.
Formatted abstract
Background: Transcatheter aortic valve implantation (TAVI) can cause profound haemodynamic perturbation in the peri-operative period. Veno-arterial extracorporeal membrane oxygenation (ECMO) can be used to provide cardiorespiratory support during this time, either prophylactically or emergently.

Method: 100 TAVI procedures were performed between 2009 and 2013 in our institution. ECMO was used in 11 patients, including eight prophylactic and three rescue cases. Rescue ECMO was required for ventricular fibrillation after valvuloplasty, and aortic annulus rupture. The criteria for prophylactic ECMO included heart failure requiring stabilisation pre-TAVI, haemodynamic instability with balloon aortic valvuloplasty performed to improve heart function pre-TAVI, moderate or severe left and/or right ventricular failure, or borderline haemodynamics at procedure. Differences in preoperative characteristics and postoperative outcomes between ECMO and non-ECMO TAVI patients were compared, and significant results were further assessed controlling for EuroSCORE.

Results: Compared to TAVI patients who did not require ECMO, ECMO patients had significantly higher mean EuroSCORE (51 vs. 30%, p < .05). Postoperative outcomes, however, were largely comparable between the two groups. All-cause mortality occurred in nil prophylactic ECMO patients, one rescue ECMO patient, and two non-ECMO patients. The difference in mortality between ECMO and non-ECMO patients was not significantly different (9 vs. 2%; p > .05). ECMO patients were more likely to develop acute renal failure than non-ECMO patients (36 vs. 8%, p < .05), which was most likely due to haemodynamic collapse and end-organ dysfunction in patients that required ECMO rescue.

Conclusions: Instituting prophylactic ECMO in selected very high-risk patients may help avoid consequences of intra-operative complications and the need for emergent rescue ECMO.
Keyword Extracorporeal membrane oxygenation
Heart valve
Percutaneous
Aortic valve
Replacement
Cardiac shock
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 10 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 12 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Tue, 21 Oct 2014, 11:24:35 EST by System User on behalf of School of Medicine