title: Outcomes of hemodynamic support with Impella in very high-risk patients undergoing balloon aortic valvuloplasty: Results from the Global cVAD Registry.
abstract: BACKGROUND
  Reports on the role of hemodynamic support devices in patients with severe aortic stenosis (AS) and left ventricular (LV) dysfunction undergoing balloon aortic valvuloplasty (BAV) are limited.
  
  
  METHODS
  Patients were identified from the cVAD registry, an ongoing multicenter voluntary registry at selected sites in North America that have used Impella in >10 patients.
  
  
  RESULTS
  A total of 116 patients with AS who underwent BAV with Impella support were identified. Mean age was 80.41±9.03years and most patients were male. Mean STS score was 18.77%±18.32, LVEF was 27.14%±16.07, and 42% underwent concomitant PCI. In most cases Impella was placed electively prior to BAV, whereas 26.7% were placed as an emergency. The two groups had similar baseline characteristics except for higher prevalence of CAD and lower LVEF in the elective group, and higher STS score in the emergency group. Elective strategy was associated higher 1-year survival compared to emergency placement (56% vs. 29.2%, p=0.003). One-year survival was higher when BAV was used as a bridge to definitive therapy as opposed to palliative treatment (90% vs. 28%, p<0.001). On multivariate analysis, STS score and aim of BAV (bridge to definitive therapy vs. palliative indication) were independent predictors of mortality.
  
  
  CONCLUSIONS
  In this large cohort of patients with AS and severe LV dysfunction undergoing BAV, our results demonstrates feasibility and promising long-term outcomes using elective Impella support with the intention to bridge to a definitive therapy.
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: vikas.dr.singh@gmail.com.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.affiliation: Penn State Milton S. Hershey Medical Center, Hershey, PA, United States.
authors.forename: Pradeep K
authors.initials: PK
authors.lastname: Yadav
authors.affiliation: Henry Ford Hospital, Detroit, MI, United States.
authors.forename: Marvin H
authors.initials: MH
authors.lastname: Eng
authors.affiliation: Baylor College of Medicine, Houston, TX, United States.
authors.forename: Francisco Yuri
authors.initials: FY
authors.lastname: Macedo
authors.affiliation: Baylor College of Medicine, Houston, TX, United States; Texas Heart Institute, Houston, TX, United States.
authors.forename: Guilherme V
authors.initials: GV
authors.lastname: Silva
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL, United States.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Mendirichaga
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL, United States.
authors.forename: Amit P
authors.initials: AP
authors.lastname: Badiye
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Rahul
authors.initials: R
authors.lastname: Sakhuja
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Sammy
authors.initials: S
authors.lastname: Elmariah
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Inglessis
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL, United States.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Alfonso
authors.affiliation: Detroit Medical Center and Wayne State University, Detroit, MI, United States.
authors.forename: Theodore L
authors.initials: TL
authors.lastname: Schreiber
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL, United States.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Cohen
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Igor
authors.initials: I
authors.lastname: Palacios
authors.affiliation: Henry Ford Hospital, Detroit, MI, United States.
authors.forename: William W
authors.initials: WW
authors.lastname: O'Neill
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000379:methods* / Q000639:trends; D006328:Cardiac Catheterization / Q000379:methods / Q000639:trends; D015331:Cohort Studies; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000628:therapy
keywords: Aortic stenosis; Balloon aortic valvuloplasty; Impella; Left ventricular dysfunction