Eastern Cardiothoracic Surgical Society

Univariate Comparison of Patients Going on Cardiopulmonary Bypass During Transcatheter Aortic Valve Replacement
Matthew J. Kramer, Fenton McCarthy, Pavan Atluri, Prashanth Vallabhajosyula, Howard Herrmann, Robert H. Li, Lisa Walsh, Saif Anwaruddin, Jay Giri, Wilson Szeto, Nimesh Desai, Joseph Bavaria
University of Pennsylvania, Philadelphia, PA

OBJECTIVE: Transcatheter aortic valve replacement (TAVR) is a new approach to aortic valve replacement. Along with severe aortic stenosis, these patients tend to be older and have more comorbidities. Cardiopulmonary Bypass (CPB) is not part of TAVR and instead used to salvage patients from difficult clinical/technical situations. Predicting which TAVR patients are more likely to require CPB remains unknown.

METHODS: Between November 2007 and June 2012, 334 patients underwent TAVR at a single institution. Out of those 334 procedures, 14 patients required CPB. Univariate comparisons are used to predict factors associated with CPB, and a Kaplan-Meier curve was used for long-term survival analysis.

RESULTS: Preoperative demographics: there was an increased previous myocardial infarction in the CPB group (71% vs 24%, p<.0004). Meanwhile being male was not (169 {52%} vs 4 (29%) {p<.1012}]. No Differences including creatinine levels (non bypass: (1.25 .67 vs CPB: (1.29 .45 P<.825), Hypertension: (295 {92%}) vs (13 {92%} P<1.0), [EF<35%]:(44 {13%})vs (3 {21%} P<.427). Differences between the Non CPB and CPB were Mild AI: (118 {36%}) vs ( 7 {50%}), Moderate MR: (123 {38%}) vs (11 {78%}). Postoperatively, increased operative mortality was significantly higher in bypass patients versus non bypass patients (5 {1.5%}) vs (8 {57%} p<.0001}. Adverse outcomes included Prolonged ventilation: (41 {12.8%} vs (8 {57%} P<.002)

CONCLUSIONS: Overall, relatively few TAVR patients required CPB. Factors such as prior MI, mild AI, and moderate MR are associated with utilizing CPB. For those patients who did go on bypass, there was increased prolonged ventilation and operative mortality.

Non CPB vs CPB Patient Data Points

Characteristic Non CPB n=320 CPB n=14 P value
Sex male 169 (52%) 4 (29%) .1012
Age 83 7 85 5 .9525
Creatinine Level 1.25 .67 1.29 .45 .825
Hypertension 295 (92%) vs P<1.0 13 (92%) 1.00
Prior MI 77 (24%) 10 (71%) .0004
EF <35% 44 (13%) 3 (21%) .427
Aortic Gradient 49.8 14 46 9.4 .9548
DC mortality 5 (1.5%) 8 (57%) .0001
Neuro-Stroke 6 (1.8%) 2 (14%) .0396