Temporary Mechanical Circulatory Support Use During Transcatheter Aortic Valve Replacement
Benjamin L. Shou1, Arjun Verma2, Alice L. Zhou1, Stefano Schena1, Peyman Benharash2, Chun Woo Choi1.
1Johns Hopkins School of Medicine, Baltimore, MD, USA, 2University of California, Los Angeles, Los Angeles, CA, USA.
Although rare, patients undergoing transcatheter aortic valve replacement (TAVR) may require the use of temporary mechanical circulatory support (tMCS) to rescue acute circulatory failure. We sought to characterize the prevalence, trends, and predictors of tMCS usage during TAVR using the largest national cohort to-date.
The 2012-2018 National Inpatient Sample (NIS) was queried for adult patients who underwent isolated TAVR. The tMCS group included those who underwent extracorporeal membrane oxygenation (ECMO), percutaneous ventricular assist device (PVAD), or intra-aortic balloon pump (IABP) during the index hospitalization. We evaluated trends in the utilization of tMCS using a rank-based, non-parametric test. We used logistic regression to evaluate mortality and identify predictors of tMCS by comparing those requiring tMCS to those who did not.
Of an estimated 215,595 patients who underwent TAVR, 3,085 (1.4%) required tMCS during their hospital course. The most common type of tMCS was IABP (53.5%), followed by ECMO (31.3%) then PVAD (21.7%). 6.3% of tMCS patients had more than one support modality. The rate of tMCS usage decreased over the study period, from 3.1% in 2012 to 1.0% in 2018 (nptrend<0.01, Figure 1). tMCS use resulted in an 18-fold increase in the odds of mortality (adjusted OR: 18.0, 95% CI: 14.2-22.9, p<0.001). Heart failure, neurologic disorders, coagulopathy, and liver disease were significantly associated with increased odds of tMCS use (Table 1).
The use of tMCS during TAVR, though rare and decreasing over time, remains a challenge associated with significant morbidity and mortality.
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