title: Safety, Feasibility, and Hemodynamic Effects of Mild Hypothermia in Transcatheter Aortic Valve Replacement: The TAVR-CHILL Trial.
abstract: The safety, feasibility, and hemodynamic effects of mild hypothermia (MH) induced by transnasal cooling were studied in transcatheter aortic valve replacement (TAVR). MH is a common therapy following cardiac arrest and seems to have favorable effects in myocardial infarction and on hemodynamic stability. In TAVR, hemodynamic instability is common during rapid pacing. Twenty subjects undergoing TAVR were randomized 1:1 to hypothermia or normothermia. Hemodynamic endpoints were mean arterial blood pressure and required dosage of vasoactive and inotropic drugs. Patients were followed up at 6 months. All patients in the MH group (n=10) reached the target temperature of 34°C before first rapid pacing. Tympanic and urinary bladder temperature remained significantly lower in the MH group during the procedure. No adverse effects of cooling were observed. Mean arterial pressure was higher in the MH group (90±20 mm Hg) than in the control group (71±13 mm Hg) at the start of the procedure, at first rapid pacing (94±19 vs. 80±16 mm Hg), and at balloon aortic valvuloplasty (90±17 vs. 73±14 mm Hg). Less norepinephrine was administered to the hypothermia group. Transnasal cooling during TAVR was safe and well tolerated. We observed a more stable hemodynamic profile in the MH group, indicated by higher blood pressure and lower levels of vasoactive drugs required. A larger study of patients with severe ventricular dysfunction is required to more comprehensively investigate the hemodynamic effects of transnasal cooling in TAVR.
authors.affiliation: 1 Department of Coronary Heart Disease, Skane University Hospital, Lund University , Lund, Sweden .|2 Department of Cardiology, Skane University Hospital , Lund University, Lund, Sweden .
authors.forename: David J L
authors.initials: DJ
authors.lastname: Zughaft
authors.affiliation: 3 Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Skane University Hospital, Lund University , Lund, Sweden .
authors.forename: Snejana
authors.initials: S
authors.lastname: Hyllén
authors.affiliation: 1 Department of Coronary Heart Disease, Skane University Hospital, Lund University , Lund, Sweden .|2 Department of Cardiology, Skane University Hospital , Lund University, Lund, Sweden .
authors.forename: Jan
authors.initials: J
authors.lastname: Harnek
authors.affiliation: 3 Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Skane University Hospital, Lund University , Lund, Sweden .
authors.forename: Shahab
authors.initials: S
authors.lastname: Nozohoor
authors.affiliation: 3 Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Skane University Hospital, Lund University , Lund, Sweden .
authors.forename: Henrik
authors.initials: H
authors.lastname: Bjursten
authors.affiliation: 1 Department of Coronary Heart Disease, Skane University Hospital, Lund University , Lund, Sweden .|2 Department of Cardiology, Skane University Hospital , Lund University, Lund, Sweden .
authors.forename: Matthias
authors.initials: M
authors.lastname: Götberg
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000187:drug effects / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D063126:Balloon Valvuloplasty; D001833:Body Temperature Regulation; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D002304:Cardiac Pacing, Artificial; D005240:Feasibility Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage; D011446:Prospective Studies; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000316:Adrenergic alpha-Agonists; D009638:Norepinephrine