Emergency extracorporeal membrane oxygenation in transcatheter aortic valve implantation: A two-center experience of incidence, outcome and temporal trends from 2010 to 2015
Teresa Trenkwalder MD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Search for more papers by this authorCostanza Pellegrini MD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Search for more papers by this authorAndreas Holzamer MD
Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie, University of Regensburg Medical Center, Regensburg, Germany
Search for more papers by this authorAlois Philipp
Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie, University of Regensburg Medical Center, Regensburg, Germany
Search for more papers by this authorTobias Rheude MD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Search for more papers by this authorJonathan Michel MBBS, BSc
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Search for more papers by this authorWibke Reinhard MD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Search for more papers by this authorMichael Joner MD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
Search for more papers by this authorAlbert M. Kasel MD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Search for more papers by this authorAdnan Kastrati MD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
Search for more papers by this authorHeribert Schunkert MD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
Search for more papers by this authorDierk Endemann MD
Klinik und Poliklinik für Innere Medizin II, University of Regensburg Medical Center, Regensburg, Germany
Search for more papers by this authorKurt Debl MD
Klinik und Poliklinik für Innere Medizin II, University of Regensburg Medical Center, Regensburg, Germany
Search for more papers by this authorN. Patrick Mayr MD
Institut für Anästhesiologie, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Search for more papers by this authorMichael Hilker MD
Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie, University of Regensburg Medical Center, Regensburg, Germany
Search for more papers by this authorCorresponding Author
Christian Hengstenberg MD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
Correspondence Christian Hengstenberg, MD, Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany. Email: [email protected]Search for more papers by this authorOliver Husser MD, PhD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Search for more papers by this authorTeresa Trenkwalder MD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Search for more papers by this authorCostanza Pellegrini MD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Search for more papers by this authorAndreas Holzamer MD
Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie, University of Regensburg Medical Center, Regensburg, Germany
Search for more papers by this authorAlois Philipp
Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie, University of Regensburg Medical Center, Regensburg, Germany
Search for more papers by this authorTobias Rheude MD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Search for more papers by this authorJonathan Michel MBBS, BSc
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Search for more papers by this authorWibke Reinhard MD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Search for more papers by this authorMichael Joner MD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
Search for more papers by this authorAlbert M. Kasel MD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Search for more papers by this authorAdnan Kastrati MD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
Search for more papers by this authorHeribert Schunkert MD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
Search for more papers by this authorDierk Endemann MD
Klinik und Poliklinik für Innere Medizin II, University of Regensburg Medical Center, Regensburg, Germany
Search for more papers by this authorKurt Debl MD
Klinik und Poliklinik für Innere Medizin II, University of Regensburg Medical Center, Regensburg, Germany
Search for more papers by this authorN. Patrick Mayr MD
Institut für Anästhesiologie, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Search for more papers by this authorMichael Hilker MD
Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie, University of Regensburg Medical Center, Regensburg, Germany
Search for more papers by this authorCorresponding Author
Christian Hengstenberg MD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
Correspondence Christian Hengstenberg, MD, Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany. Email: [email protected]Search for more papers by this authorOliver Husser MD, PhD
Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
Search for more papers by this authorAbstract
Background
Although the incidence of periprocedural complications has decreased in transcatheter aortic valve implantation (TAVI), life-threatening complications occur and emergency veno-arterial extracorporeal membrane oxygenation (vaECMO) can provide immediate circulatory stabilization. We report our two-center experience of vaECMO during life-threatening complications in TAVI.
Methods
From January 2010 to December 2015, 1,810 consecutive patients underwent TAVI at two centers. Clinical characteristics, type of complication, outcome and temporal trends in the requirement of emergency vaECMO were evaluated.
Results
Life-threatening complications requiring vaECMO occurred in 1.8% of cases (33 patients; 22 transfemoral, 11 transapical). Indications for vaECMO were ventricular rupture (30%, 10/33), low output (15%, 5/33), bleeding (12%, 4/33), coronary artery impairment (9%, 3/33), ventricular arrhythmias (6%, 2/33), severe aortic regurgitation (6%, 2/33), aortic annular rupture (6%, 2/33), and aortic dissection (3%, 1/33). In 4 cases, no definite cause for hemodynamic instability was identified. Conversion to open heart surgery was necessary in 42% of patients (14/33). Percutaneous coronary intervention was performed in all cases with coronary artery impairment (9%, 3/33). Patients with severe aortic regurgitation (6%, 2/33) underwent emergency valve-in-valve implantation. Other patients received, in addition to vaECMO support conservative treatment (42%, 14/33). In-hospital mortality and 30-day mortality were 46% (15/33). Of patients discharged, 67% (12/18) had no neurological impairment, whereas mild and severe neurological impairment was found in 11% (2/18) and 22% (4/18), respectively. From 2010 to 2015, with increasing procedures (from n = 43 to n = 553) requirement of vaECMO decreased from 9.3% to 0.9% (P for the trend <0.001).
Conclusion
Over a 6-year period, need for emergency vaECMO during TAVI significantly decreased over time. Despite high in-hospital mortality, vaECMO represents a feasible strategy for hemodynamic support in case of life-threatening complications.
CONFLICT OF INTEREST
The authors of this manuscript have no conflict of interest to disclose.
Supporting Information
Additional Supporting Information may be found online in the supporting information tab for this article.
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TABLE S1 Valve characteristics TABLE S2 Baseline characteristics TABLE S3 TAVI access |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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