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Outcomes of patients requiring extracorporeal membrane oxygenation in transcatheter aortic valve implantation: a clinical case series

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Abstract

Transcatheter aortic valve implantation (TAVI) has been established as a low-invasive therapy for aortic stenosis, but circulatory collapse necessitating mechanical circulatory support could occur during TAVI due to procedure itself or procedural complications. The purpose of this study is to describe the outcomes of patients requiring extracorporeal membrane oxygenation (ECMO) in TAVI. Among 384 consecutive patients undergoing TAVI from April 2010 to July 2017 in Sakakibara Heart Institute, we evaluated seven patients (1.8%) who required ECMO during procedure. The definitions of outcome were derived from Valve Academic Research Consortium-2 criteria. The indication of ECMO included bridge to emergent surgery due to mechanical complication (n = 3) [aortic root rupture (n = 2), and left-ventricle rupture (n = 1); emergent use], bridge to recovery from cardiac stunning (n = 3; emergent use), and circulatory support for cardiogenic shock (n = 1; prophylactic use). All patients were cannulated from femoral artery and vein, and there was no ECMO-related complication. Six out of seven patients were weaned from ECMO during the TAVI procedure, whereas the other patient with annulus rupture died the following day after TAVI. Five patients survived to discharge [postoperative hospital stay: 27.6 ± 24.3 (23) days]. During mean follow-up of 253 days, a total of three patients died due to annulus rupture, refractory heart failure, and pneumonia, respectively. ECMO is effective and a safe mechanical support device during TAVI. The mid-term outcomes of patients who needed ECMO were unfavorable. Further evolution of transcatheter heart valve is essential, and prophylactic ECMO may contribute to better prognosis in selected patients.

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Acknowledgements

We are extremely grateful to Yuko Utanohara, Keitaro Mahara, and Kazuhiro Naito for their support in implementation of TAVI.

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Authors and Affiliations

  1. Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo, 183-0003, Japan

    Ryosuke Higuchi, Tetsuya Tobaru, Kenichi Hagiya, Mike Saji, Itaru Takamisawa, Nobuo Iguchi, Morimasa Takayama & Mitsuaki Isobe

  2. Department of Anesthesiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo, 183-0003, Japan

    Jun Shimizu

  3. Department of Cardiovascular Surgery, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo, 183-0003, Japan

    Shuichiro Takanashi

Authors
  1. Ryosuke Higuchi
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  2. Tetsuya Tobaru
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  3. Kenichi Hagiya
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  4. Mike Saji
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  5. Itaru Takamisawa
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  6. Jun Shimizu
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  7. Nobuo Iguchi
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  8. Shuichiro Takanashi
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  9. Morimasa Takayama
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  10. Mitsuaki Isobe
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Correspondence to Ryosuke Higuchi.

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Conflict of interest

Dr. Tobaru is the proctor for Edwards Lifesciences and Medtronic. The other authors have no potential conflict of interest relevant to this article.

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Higuchi, R., Tobaru, T., Hagiya, K. et al. Outcomes of patients requiring extracorporeal membrane oxygenation in transcatheter aortic valve implantation: a clinical case series. Heart Vessels 33, 1343–1349 (2018). https://doi.org/10.1007/s00380-018-1183-8

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  • DOI: https://doi.org/10.1007/s00380-018-1183-8

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