1
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Ostadal P, Vondrakova D, Popkova M, Hrachovina M, Kruger A, Janotka M, Naar J, Kittnar O, Neuzil P, Mlcek M. Aortic stenosis and mitral regurgitation modify the effect of venoarterial extracorporeal membrane oxygenation on left ventricular function in cardiogenic shock. Sci Rep 2022; 12:17076. [PMID: 36224296 PMCID: PMC9556561 DOI: 10.1038/s41598-022-21501-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/28/2022] [Indexed: 01/04/2023] Open
Abstract
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is widely used in the treatment of patients experiencing cardiogenic shock (CS). However, increased VA-ECMO blood flow (EBF) may significantly impair left ventricular (LV) performance. The objective of the present study was to assess the effect of VA-ECMO on LV function in acute CS with concomitant severe aortic stenosis (AS) or mitral regurgitation (MR) in a porcine model. Eight female swine (45 kg) underwent VA-ECMO implantation under general anaesthesia and mechanical ventilation. Acute CS was induced by global myocardial hypoxia. Subsequently, severe AS was simulated by obstruction of the aortic valve, while severe MR was induced by mechanical destruction of the mitral valve. Haemodynamic and LV performance variables were measured at different rates of EBF rates (ranging from 1 to 4 L/min), using arterial and venous catheters, a pulmonary artery catheter, and LV pressure-volume catheter. Data are expressed as median (interquartile range). Myocardial hypoxia resulted in declines in cardiac output to 2.7 (1.9-3.1) L/min and LV ejection fraction to 15.2% (10.5-19.3%). In severe AS, increasing EBF from 1 to 4 L/min was associated with a significant elevation in mean arterial pressure (MAP), from 33.5 (24.2-34.9) to 56.0 (51.9-73.3) mmHg (P ˂ 0.01). However, LV volumes (end-diastolic, end-systolic, stroke) remained unchanged, and LV end-diastolic pressure (LVEDP) significantly decreased from 24.9 (21.2-40.0) to 19.1 (15.2-29.0) mmHg (P ˂ 0.01). In severe MR, increasing EBF resulted in a significant elevation in MAP from 49.0 (28.0-53.4) to 72.5 (51.4-77.1) mmHg (P ˂ 0.01); LV volumes remained stable and LVEDP increased from 17.1 (13.7-19.1) to 20.8 (16.3-25.6) mmHg (P ˂ 0.01). Results of this study indicate that the presence of valvular heart disease may alleviate negative effect of VA-ECMO on LV performance in CS. Severe AS fully protected against LV overload, and partial protection was also detected with severe MR, although at the cost of increased LVEDP and, thus, higher risk for pulmonary oedema.
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Affiliation(s)
- Petr Ostadal
- grid.414877.90000 0004 0609 2583Cardiovascular Center, Na Homolce Hospital, Roentgenova 2, 15000 Prague, Czech Republic
| | - Dagmar Vondrakova
- grid.414877.90000 0004 0609 2583Cardiovascular Center, Na Homolce Hospital, Roentgenova 2, 15000 Prague, Czech Republic
| | - Michaela Popkova
- grid.4491.80000 0004 1937 116XDepartment of Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Matej Hrachovina
- grid.4491.80000 0004 1937 116XDepartment of Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Andreas Kruger
- grid.414877.90000 0004 0609 2583Cardiovascular Center, Na Homolce Hospital, Roentgenova 2, 15000 Prague, Czech Republic
| | - Marek Janotka
- grid.414877.90000 0004 0609 2583Cardiovascular Center, Na Homolce Hospital, Roentgenova 2, 15000 Prague, Czech Republic
| | - Jan Naar
- grid.414877.90000 0004 0609 2583Cardiovascular Center, Na Homolce Hospital, Roentgenova 2, 15000 Prague, Czech Republic
| | - Otomar Kittnar
- grid.4491.80000 0004 1937 116XDepartment of Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Petr Neuzil
- grid.414877.90000 0004 0609 2583Cardiovascular Center, Na Homolce Hospital, Roentgenova 2, 15000 Prague, Czech Republic
| | - Mikulas Mlcek
- grid.4491.80000 0004 1937 116XDepartment of Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
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2
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Ishizu K, Kawaguchi T, Shirai S, Ando K. Retrograde balloon aortic valvuloplasty with the newly invented Inoue balloon for aortic stenosis accompanied by severe heart failure: A case report. Clin Case Rep 2021; 9:2011-2015. [PMID: 33936631 PMCID: PMC8077365 DOI: 10.1002/ccr3.3928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 11/23/2022] Open
Abstract
Retrograde balloon aortic valvuloplasty using the newly invented Inoue balloon was one of the feasible and safe therapeutic options in a hemodynamically unstable patient having aortic stenosis with reduced left ventricular ejection fraction complicated with bacterial infection.
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Affiliation(s)
- Kenichi Ishizu
- Department of Cardiovascular MedicineKokura Memorial HospitalKitakyushuJapan
| | - Tomohiro Kawaguchi
- Department of Cardiovascular MedicineKokura Memorial HospitalKitakyushuJapan
| | - Shinichi Shirai
- Department of Cardiovascular MedicineKokura Memorial HospitalKitakyushuJapan
| | - Kenji Ando
- Department of Cardiovascular MedicineKokura Memorial HospitalKitakyushuJapan
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3
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Ahsan M, Jánosi RA, Rassaf T, Lind A. Use of extracorporeal membrane oxygenation as a bridge to transcatheter aortic valve replacement in a patient with aortic stenosis and severe coronary artery disease: a case report. Eur Heart J Case Rep 2021; 5:ytaa567. [PMID: 33501410 PMCID: PMC7809724 DOI: 10.1093/ehjcr/ytaa567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/14/2020] [Accepted: 12/18/2020] [Indexed: 11/22/2022]
Abstract
Background Patients with severe aortic stenosis (AS) often present with multiple comorbidities and suffer from critical coronary artery disease (CAD). Transcatheter aortic valve replacement (TAVR) has become the therapy of choice for moderate to high-risk patients. Venoarterial extracorporeal membrane oxygenation (v-a-ECMO) offers the possibility of temporary cardiac support to manage life-threatening critical situations. Case summary Here, we describe the management of a patient with severe AS and CAD with impaired left ventricular ejection fraction (LVEF). We used v-a-ECMO as an emergency strategy in cardiogenic shock during a high-risk coronary intervention to stabilize the patient, and as a further bridge to TAVR. Discussion Very high-risk patients with severe AS are unlikely to tolerate the added risk of surgical aortic valve replacement. Using ECMO may help them to benefit from TAVR as the only treatment option available.
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Affiliation(s)
- Majid Ahsan
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Rolf Alexander Jánosi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Alexander Lind
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
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4
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Kmiec L, Holzamer A, Fischer M, Debl K, Zerdzitzki M, Schmid C, Maier L, Hilker M, Sossalla S. Protected complex percutaneous coronary intervention and transcatheter aortic valve replacement using extracorporeal membrane oxygenation in a high-risk frail patient: a case report. J Med Case Rep 2020; 14:163. [PMID: 32962754 PMCID: PMC7510274 DOI: 10.1186/s13256-020-02474-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement has become a routine procedure for patients with severe symptomatic aortic stenosis at increased surgical risk. Not much is known about using prophylactic support with venoarterial extracorporeal membrane oxygenation in patients undergoing transcatheter aortic valve replacement and eventually concomitant complex percutaneous coronary intervention. CASE PRESENTATION We present a successful procedure of transcatheter aortic valve replacement and high-risk percutaneous coronary intervention utilizing venoarterial extracorporeal membrane oxygenation for hemodynamic support in a very frail 88-year-old Caucasian woman with severe symptomatic aortic stenosis and coronary bypass grafting in the past. Echocardiography revealed a "low-flow low-gradient" aortic stenosis (mean transvalvular gradient 30 mmHg, aortic valve area 0.4 cm2, significant calcification), a left ventricular ejection fraction of 35%, severe mitral regurgitation with moderate stenosis (mean transvalvular gradient 7 mmHg), with a systolic pulmonary artery pressure of 80 mmHg. Moreover, pre-interventional coronary angiography exposed a severe left main ostial stenosis and sequential subtotal heavily calcified stenosis of the left anterior descending artery . Computed tomographic angiography showed no heavy tortuosity but moderate calcification of the iliofemoral arteries. The procedure was performed under general anesthesia in our hybrid operating room. Extracorporeal membrane oxygenation was established by left femoral percutaneous cannulation using a 21-Fr venous and 15-Fr arterial cannula. Subsequently, complex percutaneous coronary intervention with implantation of two drug-eluting stents from the left main into the left anterior descending artery was performed via a right femoral arterial 7F sheath. Thereafter, a 23-mm Sapien 3 aortic valve prosthesis (Edwards, Irvine, CA, USA) was implanted via right femoral artery in the usual manner, whereby the arterial pigtail catheter for marking the aortic annulus during transcatheter aortic valve replacement was inserted over a Check-Flo® Hemostasis Assembly (Cook Medical, Bloomington, IN, USA) on a Y-adapter via the arterial extracorporeal membrane oxygenation cannula. After extracorporeal membrane oxygenation decannulation, vascular closure was easily performed using the MANTA vascular closure device in order to reduce procedural time and risk of access site complications. CONCLUSIONS In summary, we demonstrate the feasibility of elective prophylactic extracorporeal membrane oxygenation implementation in selected very high-risk and frail patients undergoing transcatheter aortic valve replacement and percutaneous coronary intervention in order to avoid intraprocedural complications.
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Affiliation(s)
- Lukasz Kmiec
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Andreas Holzamer
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Marcus Fischer
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Kurt Debl
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Matthäus Zerdzitzki
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Lars Maier
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Michael Hilker
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Samuel Sossalla
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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5
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Franzese I, Cetera V, Pesarini G, Onorati F, Ribichini FL, Faggian G, Milano AD. Transapical mitral valve-in-valve procedure with elective venoarterial ECMO in a patient with severe kyphoscoliosis. J Card Surg 2020; 35:3217-3219. [PMID: 32790016 DOI: 10.1111/jocs.14949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 11/27/2022]
Abstract
Transcatheter mitral valve-in-valve replacement (TMVR) is a feasible alternative in high-risk patients requiring reoperation for failing mitral bioprosthesis. Such patients may present with hemodynamic instability or sudden complications, which may jeopardize the outcomes. We report a successful transapical TMVR in a patient, with severe kyphoscoliosis and on prolonged mechanical ventilation, with prophylactic extracorporeal membrane oxygenator support. This combined procedure may be helpful to reduce the complications of TMVR in critically ill subjects.
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Affiliation(s)
- Ilaria Franzese
- Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Vera Cetera
- Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Onorati
- Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Giuseppe Faggian
- Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Aldo D Milano
- Department of Emergency and Organ Transplants, Cardiac Surgery Unit, University of Bari Medical School, Bari, Italy
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6
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Taninobu K, Miura M, Shirai S, Hayashi M, Ishibashi M, Takiguchi H, Ito S, Yano M, Kawaguchi T, Morinaga T, Isotani A, Kakumoto S, Seo K, Arai Y, Sakaguchi G, Ando K. Transcatheter aortic valve implantation for patients with low left ventricular ejection fraction under prophylactic use of veno-arterial extracorporeal membrane oxygenation. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2020. [DOI: 10.23736/s0393-3660.19.04153-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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7
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Castrodeza J, Serrador Frutos AM, Amat-Santos IJ, Sayago Silva I, San Román JA. Prophylactic percutaneous circulatory support in high risk transcatheter aortic valve implantation. Cardiol J 2019; 26:424-426. [PMID: 31452190 DOI: 10.5603/cj.2019.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/13/2019] [Accepted: 01/21/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Javier Castrodeza
- Department of Cardiology, Institute of Heart Sciences (ICICOR), Hospital Clínico Universitario, Valladolid, Spain.
| | - Ana Mª Serrador Frutos
- Department of Cardiology, Institute of Heart Sciences (ICICOR), Hospital Clínico Universitario, Valladolid, Spain
| | - Ignacio J Amat-Santos
- Department of Cardiology, Institute of Heart Sciences (ICICOR), Hospital Clínico Universitario, Valladolid, Spain.,CIBER de Enfermedades Cardiovasculares, Spain
| | - Inés Sayago Silva
- Department of Cardiology, Institute of Heart Sciences (ICICOR), Hospital Clínico Universitario, Valladolid, Spain
| | - José Alberto San Román
- Department of Cardiology, Institute of Heart Sciences (ICICOR), Hospital Clínico Universitario, Valladolid, Spain.,CIBER de Enfermedades Cardiovasculares, Spain
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8
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Kochergin NA, Vakkosov KM, Ganyukov VI, Tarasov RS, Shloydo EA. [Transcatheter aortic valve implantation under extracorporeal membrane oxygenation]. Khirurgiia (Mosk) 2019:66-71. [PMID: 31120450 DOI: 10.17116/hirurgia201904166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has become the standard treatment for advanced age and high risk patients with severe aortic stenosis. The incidence of life-threatening complications during TAVI has significantly decreased over the last decade due to advanced current surgical experience. However, there is a risk of perioperative life-threatening complications which can require emergency hemodynamic support. Veno-arterial extracorporeal membrane oxygenation (ECMO) may represent an effective strategy for immediate hemodynamic stabilization until further treatment of the underlying complication. It is presented case report of TAVI under ECMO performed at the Kemerovo Research Institute for Complex Issues of Cardiovascular Diseases. Emergency ECMO represents a feasible strategy for stabilization until further treatment of life-threatening complications during TAVI.
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Affiliation(s)
- N A Kochergin
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - K M Vakkosov
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - V I Ganyukov
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - R S Tarasov
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - E A Shloydo
- Municipal Multi-field hospital #2, Saint Petersburg, Russia
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9
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Guerrero-Miranda CY, Hall SA. Cardiac catheterization and percutaneous intervention procedures on extracorporeal membrane oxygenation support. Ann Cardiothorac Surg 2019; 8:123-128. [PMID: 30854321 DOI: 10.21037/acs.2018.11.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) is used to support critically ill patients when conventional therapies have failed. ECMO has been available for four decades and has gained use as a rescue therapy in severe refractory hypoxic disorders and in patients with refractory cardiogenic shock (RCS). Over recent years, several percutaneous cardiac interventions and implant devices have been developed that are now used frequently in conjunction with ECMO in order to maintain organ perfusion. Here, we review the literature on VA-ECMO cannulation location, the use of VA-ECMO in interventions (e.g., coronary interventions and structural heart interventions) and percutaneous cardiac device implantation in VA-ECMO recipients with RCS.
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Affiliation(s)
- Cesar Y Guerrero-Miranda
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA.,Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX, USA.,Department of Internal Medicine, Texas A & M University Health Science Center, Dallas, TX, USA
| | - Shelley A Hall
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA.,Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX, USA.,Department of Internal Medicine, Texas A & M University Health Science Center, Dallas, TX, USA
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10
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Vallabhajosyula S, Patlolla SH, Sandhyavenu H, Vallabhajosyula S, Barsness GW, Dunlay SM, Greason KL, Holmes DR, Eleid MF. Periprocedural Cardiopulmonary Bypass or Venoarterial Extracorporeal Membrane Oxygenation During Transcatheter Aortic Valve Replacement: A Systematic Review. J Am Heart Assoc 2018; 7:JAHA.118.009608. [PMID: 29987125 PMCID: PMC6064861 DOI: 10.1161/jaha.118.009608] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND There are limited data on the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) or cardiopulmonary bypass (CPB) to provide hemodynamic support periprocedurally during transcatheter aortic valve replacement. This study sought to evaluate patients receiving transcatheter aortic valve replacement with concomitant use of CPB/VA-ECMO. METHODS AND RESULTS We systematically reviewed the published literature from 2000 to 2018 for studies evaluating adult patients requiring CPB/VA-ECMO periprocedurally during transcatheter aortic valve replacement. Studies reporting short-term and long-term mortality were included. Given the significant methodological and statistical differences between published studies, meta-analysis of the association of CPB/VA-ECMO with mortality was not performed. Of the 537 studies identified, 9 studies representing 5191 patients met our inclusion criteria. Median ages were between 75 and 87 years with 33% to 75% male patients. Where reported, the Edwards SAPIEN™ transcatheter heart valve was the most frequently used. A total of 203 (3.9%) patients received periprocedural hemodynamic support with CPB/VA-ECMO. Common indications for CPB/VA-ECMO included left ventricular or aortic annular rupture, rapid hemodynamic deterioration, aortic regurgitation, cardiac arrest, and left main coronary artery obstruction. The use of CPB/VA-ECMO was predominantly an emergent strategy and was used for durations of 1 to 2 hours. Short-term mortality (in-hospital and 30-day) was 29.8%, and 1-year mortality was 52.4%. Major complications such as bleeding, vascular injury, tamponade, stroke, and renal failure were noted in 10% to 50% of patients. CONCLUSIONS CPB/VA-ECMO was used in 4% in the early experience of patients undergoing transcatheter aortic valve replacement, most commonly for periprocedural complications. There are limited data on preprocedural planned use of VA-ECMO, and the characteristics of this population remain poorly defined.
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Affiliation(s)
| | | | | | | | | | - Shannon M Dunlay
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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11
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Use of extracorporeal membrane oxygenation in complicated transcatheter aortic valve replacement. Gen Thorac Cardiovasc Surg 2017; 65:329-336. [PMID: 28236098 DOI: 10.1007/s11748-017-0757-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES 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. CONCLUSION 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.
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12
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Makdisi G, Makdisi PB, Wang IW. Use of extracorporeal membranous oxygenator in transcatheter aortic valve replacement. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:306. [PMID: 27668226 DOI: 10.21037/atm.2016.08.14] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The superiority of transcatheter aortic valve replacement (TAVR) compared with medical therapy for patients with aortic stenosis (AS) who are not suitable candidates for surgery had been proven. Cardiopulmonary bypass (CPB) is rarely used in TAVR. Reports of early use of extracorporeal membranous oxygenator (ECMO) have promising outcomes. ECMO offers the option of cardiac support rescue in case of intraoperative hemodynamic instability and can be instituted in advance when hemodynamic instability is expected. Here we review the English literature about the use of ECMO in TAVR procedures, and discuss the indications and rationale for its use as well as its advantages.
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Affiliation(s)
- George Makdisi
- Gulf Coast Cardiothoracic Surgery Institute, Tampa General Hospital, Tampa, FL, USA
| | - Peter B Makdisi
- Division of Gynecologic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - I-Wen Wang
- Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indiana University Health, Methodist Hospital, Indianapolis, IN, USA
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13
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Chiu P, Fearon WF, Raleigh LA, Burdon G, Rao V, Boyd JH, Yeung AC, Miller DC, Fischbein MP. Salvage Extracorporeal Membrane Oxygenation Prior to "Bridge" Transcatheter Aortic Valve Replacement. J Card Surg 2016; 31:403-5. [PMID: 27109017 DOI: 10.1111/jocs.12750] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We describe a patient who presented in profound cardiogenic shock due to bioprosthetic aortic valve stenosis requiring salvage Extracorporeal Membrane Oxygenation followed by a "bridge" valve-in-valve transcatheter aortic valve replacement. doi: 10.1111/jocs.12750 (J Card Surg 2016;31:403-405).
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Affiliation(s)
- Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Lindsay A Raleigh
- Department of Anesthesiology, Stanford University School of Medicine, Stanford, California
| | - Grayson Burdon
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Vidya Rao
- Department of Anesthesiology, Stanford University School of Medicine, Stanford, California
| | - Jack H Boyd
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - David Craig Miller
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
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14
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Makdisi G, Makdisi PB, Wang IW. New horizons of non-emergent use of extracorporeal membranous oxygenator support. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:76. [PMID: 27004223 DOI: 10.3978/j.issn.2305-5839.2016.02.04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The expansion of the extra corporeal membrane oxygenation (ECMO) use and its indication is strikingly increased in the past few years. ECMO use expanded to lung transplantation, difficult general thoracic resections, transcatheter aortic valve replacement (TAVR) and LVAD implantation. Here we will discuss the indications and the outcomes of non-emergent use of ECMO.
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Affiliation(s)
- George Makdisi
- 1 Gulf Coast Cardiothoracic Surgery Institute, Tampa General Hospital, Tampa, FL, USA ; 2 Mayo Clinic College of Medicine, Rochester, MN, USA ; 3 Indiana University School of Medicine, Division of Cardiothoracic Surgery, Indiana University Health, Methodist Hospital, Indianapolis, IN, USA
| | - Peter B Makdisi
- 1 Gulf Coast Cardiothoracic Surgery Institute, Tampa General Hospital, Tampa, FL, USA ; 2 Mayo Clinic College of Medicine, Rochester, MN, USA ; 3 Indiana University School of Medicine, Division of Cardiothoracic Surgery, Indiana University Health, Methodist Hospital, Indianapolis, IN, USA
| | - I-Wen Wang
- 1 Gulf Coast Cardiothoracic Surgery Institute, Tampa General Hospital, Tampa, FL, USA ; 2 Mayo Clinic College of Medicine, Rochester, MN, USA ; 3 Indiana University School of Medicine, Division of Cardiothoracic Surgery, Indiana University Health, Methodist Hospital, Indianapolis, IN, USA
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