title: Extracorporeal Membrane Oxygenation as a Procedural Rescue Strategy for Transcatheter Aortic Valve Replacement Cardiac Complications.
abstract: Cardiovascular complications during or after transcatheter aortic valve replacement (TAVR) are associated with extremely high mortality, but extracorporeal membrane oxygenation (ECMO) can be used as procedural rescue option to improve outcomes when patients experience respiratory or cardiac arrest. From 2012 to 2014, 230 patients underwent TAVR and 10 patients (4.3%) required emergent venous-arterial ECMO support. Mean age was 83 years, median Society of Thoracic Surgeons (STS) score was 15, and mean aortic gradient was 45 mm Hg. Median left ventricular ejection fraction was 35%. Access for most ECMOs was femoral; two patients required central arterial and femoral venous access. Extracorporeal membrane oxygenation was initiated in response to hemodynamic collapse due to perforation of left ventricle (n = 2), aortic root rupture (n = 1), moderate-to-severe aortic insufficiency (n = 1), left main impingement (n = 1), valve embolization (n = 1), severe hypotension and cardiac arrest after prolonged rapid pacing sequence (n = 1), ventricular fibrillation (n = 2), and ventricular tachycardia (n = 1). Median time of ECMO support was 87 minutes. There were three hospital deaths. Post-TAVR mean aortic gradient was 8 mm Hg and median hospital stay was 19 days. Additional procedures included valve-in-valve placement (n = 1), percutaneous coronary intervention (n = 1), surgical LV repair (n = 2), surgical valve replacement (n = 1), aortic root rupture repair, and coronary bypass grafting (n = 1). Extracorporeal membrane oxygenation is rescue therapy for hemodynamic instable patients who develop TAVR-related cardiac complications.
authors: From the Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital - Texas Medical Center, Houston, Texas.
authors: Igor
authors: I
authors: Banjac
authors: Marija
authors: M
authors: Petrovic
authors: Mehmet H
authors: MH
authors: Akay
authors: Lisa M
authors: LM
authors: Janowiak
authors: Rajko
authors: R
authors: Radovancevic
authors: Sriram
authors: S
authors: Nathan
authors: Manish
authors: M
authors: Patel
authors: Pranav
authors: P
authors: Loyalka
authors: Biswajit
authors: B
authors: Kar
authors: Igor D
authors: ID
authors: Gregoric
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012769:Shock / Q000209:etiology / Q000628:therapy*; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*