Pot-pourri
Emergency and prophylactic use of miniaturised veno-arterial extracorporeal membrane oxygenation (vaECMO) in transcatheter aortic valve implantation (TAVI)
Aims: In transcatheter aortic valve implantation (TAVI) short-term mortality closely relates to life-threatening procedural complications. Veno-arterial extracorporeal membrane oxygenation (vaECMO) can be used to stabilise the patient in emergency situations. However, for the prophylactic use of vaECMO in very-high-risk patients undergoing TAVI there is no experience. We report our centre’s experience using vaECMO in TAVI.
Methods and results: From January 2009 to August 2011, we performed 131 TAVI. Emergency vaECMO was required in eight cases (7%), due to ventricular perforation (n=3), haemodynamic instability/cardiogenic shock (n=4) and haemodynamic deterioration due to ventricular tachycardia (n=1). From August 2011 onwards, prophylactic vaECMO was systematically used in very-high-risk patients (n=9, 11%) during 83 procedures and emergency vaECMO in one case (1%) due to ventricular perforation. Median logistic EuroSCORE in prophylactic vaECMO patients was considerably higher compared to the remaining TAVI population (30% vs. 15%, p=0.0003) while in patients with emergency vaECMO it was comparable (18% vs. 15%, p=0.08). Comparing prophylactic to emergency vaECMO, procedural success, procedural-related death, and 30-day mortality were 100% vs. 78% (p=0.5), 0% vs. 33% (p=0.2) and 0% vs. 44% (p=0.08), respectively. Major vascular complications and rate of life-threatening bleeding did not differ in both groups (11% vs. 11%, p=0.99 and 11% vs. 33%, p=0.6) and were not vaECMO-related.
Conclusions: Life-threatening complications during TAVI can be managed using emergency vaECMO but mortality remains high. Systematic use of prophylactic vaECMO in very-high-risk patients is safe and might be advocated in selected high-risk patients.
