TY - JOUR
T1 - Percutaneous mechanical circulatory support from the collaborative multicenter Mechanical Unusual Support in TAVI (MUST) Registry
AU - Orvin, Katia
AU - Perl, Leor
AU - Landes, Uri
AU - Dvir, Danny
AU - Webb, John George
AU - Stelzmüller, Marie Elisabeth
AU - Wisser, Wilfried
AU - Nazif, Tamim Michael
AU - George, Isaac
AU - Miura, Mizuki
AU - Taramasso, Maurizio
AU - Pilgrim, Thomas
AU - Fürholz, Monika
AU - Sinning, Jan Malte
AU - Nickenig, Georg
AU - Rumer, Chris
AU - Tarantini, Giuseppe
AU - Masiero, Giulia
AU - Bunc, Matjas
AU - Radsel, Peter
AU - Latib, Azeem
AU - Kargoli, Faraj
AU - Ielasi, Alfonso
AU - Medda, Massimo
AU - Nombela-Franco, Luis
AU - Vaknin-Assa, Hana
AU - Kornowski, Ran
N1 - Publisher Copyright:
© 2021 Wiley Periodicals LLC.
PY - 2021/11/15
Y1 - 2021/11/15
N2 - Objectives: To evaluate the use and outcomes of percutaneous mechanical circulatory support (pMCS) utilized during transcatheter aortic valve implantation (TAVI) from high-volume centers. Methods and results: Our international multicenter registry including 13 high-volume TAVI centers with 87 patients (76.5 ± 11.8 years, 63.2% men) who underwent TAVI for severe aortic stenosis and required pMCS (75.9% VA-ECMO, 19.5% Impella CP, 4.6% TandemHeart) during the procedure (prior to TAVI 39.1%, emergent rescue 50.6%, following TAVI 10.3%). The procedures were considered high-risk, with 50.6% having severe left ventricular dysfunction, 24.1% biventricular dysfunction, and 32.2% severe pulmonary hypertension. In-hospital and 1-year mortality were 27.5% and 49.4%, respectively. Patients with prophylactic hemodynamic support had lower periprocedural mortality compared to patients with rescue insertion of pMCS (log rank = 0.013) and patients who did not undergo cardiopulmonary resuscitation during the TAVI procedure had better short and long term survival (log rank <0.001 and 0.015, respectively). Conclusions: Given the overall survival rate and low frequency of pMCS-related complications, our study results support the use of pMCS prophylactically or during the course of TAVI (bailout) in order to improve clinical outcomes in high-risk procedures or in case of acute life-threatening hemodynamic collapse.
AB - Objectives: To evaluate the use and outcomes of percutaneous mechanical circulatory support (pMCS) utilized during transcatheter aortic valve implantation (TAVI) from high-volume centers. Methods and results: Our international multicenter registry including 13 high-volume TAVI centers with 87 patients (76.5 ± 11.8 years, 63.2% men) who underwent TAVI for severe aortic stenosis and required pMCS (75.9% VA-ECMO, 19.5% Impella CP, 4.6% TandemHeart) during the procedure (prior to TAVI 39.1%, emergent rescue 50.6%, following TAVI 10.3%). The procedures were considered high-risk, with 50.6% having severe left ventricular dysfunction, 24.1% biventricular dysfunction, and 32.2% severe pulmonary hypertension. In-hospital and 1-year mortality were 27.5% and 49.4%, respectively. Patients with prophylactic hemodynamic support had lower periprocedural mortality compared to patients with rescue insertion of pMCS (log rank = 0.013) and patients who did not undergo cardiopulmonary resuscitation during the TAVI procedure had better short and long term survival (log rank <0.001 and 0.015, respectively). Conclusions: Given the overall survival rate and low frequency of pMCS-related complications, our study results support the use of pMCS prophylactically or during the course of TAVI (bailout) in order to improve clinical outcomes in high-risk procedures or in case of acute life-threatening hemodynamic collapse.
KW - MUST
KW - TAVI
KW - outcome
KW - percutaneous mechanical support
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U2 - 10.1002/ccd.29747
DO - 10.1002/ccd.29747
M3 - Article
C2 - 33961729
AN - SCOPUS:85105673806
SN - 1522-1946
VL - 98
SP - E862-E869
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 6
ER -