title: Emergency and prophylactic use of miniaturized veno-arterial extracorporeal membrane oxygenation in transcatheter aortic valve implantation.
abstract: OBJECTIVE
  To report our center's experience using veno-arterial extracorporeal membrane oxygenation (vaECMO) in transcatheter aortic valve implantation (TAVI).
  
  
  BACKGROUND
  In TAVI, short-term mortality closely relates to life threatening procedural complications. VaECMO can be used to stabilize the patient in emergency situations. However, for the prophylactic use of vaECMO in very high-risk patients undergoing TAVI there is no experience.
  
  
  METHODS
  From January 2009 to August 2011, we performed 131 TAVI. Emergency vaECMO was required in 8 cases (7%): ventricular perforation (n = 3), hemodynamic instability/cardiogenic shock (n = 4), hemodynamic deterioration due to ventricular tachycardia (n = 1). Since August 2011, during 83 procedures, prophylactic vaECMO was systematically used in very high-risk patients (n = 9, 11%) and emergency ECMO in one case (1%) due to ventricular perforation.
  
  
  RESULTS
  Median logistic EuroScore in prophylactic vaECMO patients was considerably higher as 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 and 30-day mortality were 100% vs. 44% (P = 0.03) and 0% vs. 44% (P = 0.02), respectively. Major vascular complications and rate of life threatening bleeding did not differ between both groups (11% vs. 11%, P = 0.99 and 11% vs. 33%, P = 0.3) and were not vaECMO-related.
  
  
  CONCLUSIONS
  Life-threatening complications during TAVI can be managed using emergency vaECMO but mortality remains high. The use of prophylactic vaECMO in very high-risk patients is safe and may be advocated in selected cases.
authors.affiliation: Klinik und Poliklinik für Innere Medizin II, University of Regensburg Medical Center, Regensburg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Husser
authors.forename: Andreas
authors.initials: A
authors.lastname: Holzamer
authors.forename: Alois
authors.initials: A
authors.lastname: Philipp
authors.forename: Julio
authors.initials: J
authors.lastname: Nunez
authors.forename: Vicente
authors.initials: V
authors.lastname: Bodi
authors.forename: Thomas
authors.initials: T
authors.lastname: Müller
authors.forename: Matthias
authors.initials: M
authors.lastname: Lubnow
authors.forename: Andreas
authors.initials: A
authors.lastname: Luchner
authors.forename: Dirk
authors.initials: D
authors.lastname: Lunz
authors.forename: Günter A J
authors.initials: GA
authors.lastname: Riegger
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
authors.forename: Christian
authors.initials: C
authors.lastname: Hengstenberg
authors.forename: Michael
authors.initials: M
authors.lastname: Hilker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology* / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002114:Calcinosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016009:Chi-Square Distribution; D004630:Emergencies; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D016015:Logistic Models; D008297:Male; D008904:Miniaturization; D011475:Prosthesis Failure; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: emergency; extracorporeal membrane oxygenation; procedural complications; prophylactic; transcatheter aortic valve implantation