title: Use of extracorporeal membrane oxygenation in complicated transcatheter aortic valve replacement.
abstract: OBJECTIVE
  Although transcatheter aortic valve replacement (TAVR) is an excellent alternative procedure for high-risk patients with severe symptomatic aortic stenosis, it is often associated with life-threatening complications. We report on the emergency or elective use of veno-arterial extracorporeal membrane oxygenation (ECMO) to manage these complications.
  
  
  METHODS
  Between December 2013 and February 2016, 46 patients underwent TAVR at our institution. Of these, 4 patients required emergency ECMO support and another 3 patients were electively placed on ECMO support at the start of the procedure. The mean age of the ECMO patients was 87.3 ± 3.6 years and all were female. The Society of Thoracic Surgeons-predicted risk of mortality score in these patients was 12.2 ± 6.2%.
  
  
  RESULTS
  TAVR with ECMO was completed through the transapical approach in 6 patients, and the transfemoral approach in 1 patient. The arterial access route for ECMO was the femoral artery in 5, the external iliac artery in 1, and the subclavian artery in 1. Indications for the use of emergency ECMO were hemodynamic instability in 2, cardiogenic shock in 2, while indications for elective ECMO were severe pulmonary hypertension, impaired left ventricular function and a combination of these. There was no 30-day mortality, and the 1-year survival rate was 83.3% with no significant difference compared to patients without ECMO support.
  
  
  CONCLUSIONS
  The use of ECMO in very high-risk patients undergoing TAVR may increase safety and contribute to excellent outcomes. Although ECMO support is rarely needed in TAVR, a well-prepared treatment strategy by the heart team is mandatory.
authors.affiliation: Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan.
authors.forename: Kyokun
authors.initials: K
authors.lastname: Uehara
authors.affiliation: Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan. minakata@kuhp.kyoto-u.ac.jp.
authors.forename: Kenji
authors.identifier: http://orcid.org/0000-0002-4487-8224
authors.initials: K
authors.lastname: Minakata
authors.affiliation: Department of Cardiology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Naritatsu
authors.initials: N
authors.lastname: Saito
authors.affiliation: Department of Cardiology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Imai
authors.affiliation: Department of Anesthesiology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Daijo
authors.affiliation: Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Nakatsu
authors.affiliation: Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Sakamoto
authors.affiliation: Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yamazaki
authors.affiliation: Department of Cardiology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan.
authors.forename: Ryuzo
authors.initials: R
authors.lastname: Sakata
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: Aortic stenosis; Cardiogenic shock; Complications; Extracorporeal membrane oxygenation; Transcatheter aortic valve replacement