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Prophylactic ECMO during TAVI in patients with depressed left ventricular ejection fraction

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Abstract

Background

This study investigated the impact of prophylactic veno-arterial extracorporeal membrane oxygenation (pECMO) in patients with depressed left ventricular ejection fraction (dLVEF) undergoing transcatheter aortic valve implantation (TAVI).

Methods

Out of 1490 patients undergoing TAVI at two centers (2010–2015), 222 patients had dLVEF (≤ 40%). Of these, 21 patients (10%) underwent TAVI with pECMO. Complications and outcome according to pECMO were analyzed in the entire and in a propensity-matched population.

Results

In the entire population, patients with pECMO had a higher logEuroScore I (33% ± 19 vs. 25% ± 17; p = 0.037), worse LVEF (26% ± 7 vs. 32% ± 7; p = 0.001), more major bleedings (29% vs. 9%; p = 0.015), higher transfusion rate (30% vs. 10%; p = 0.019) and longer in-hospital stay (9.0 [7.0;14.0] vs. 7.0 [5.0;10.0] days; p = 0.024). After propensity matching only transfusion rate remained higher with pECMO (30% vs. 7%; p = 0.025). In the entire population, rate and risk of 30-day mortality was higher with pECMO (24% vs. 6%, HR 95%CI 4.29 [1.51–12.19]; p = 0.006). In the matched population, this effect was attenuated (24% vs. 12%, HR 95%CI 2.09 [0.61–7.23]; p = 0.243). Cumulative rate and risk of 1-year mortality did not differ in the entire (log-rank p = 0.069; 39% vs. 22%, HR 95%CI 1.99 [0.94–4.24]; p = 0.074) nor in the matched population (log-rank p = 0.520; 39% vs. 31%, HR 95%CI 1.34 [0.55–3.28]; p = 0.523).

Conclusion

In patients with dLVEF undergoing TAVI, periprocedural pECMO support does not seem to improve patient outcome.

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Funding

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Author information

Authors and Affiliations

  1. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Lazarettstrasse 36, 80636, Munich, Germany

    Teresa Trenkwalder, Costanza Pellegrini, Tobias Rheude, Josef Riester, Wibke Reinhard, Albert M. Kasel, Adnan Kastrati, Heribert Schunkert, Michael Joner, Christian Hengstenberg & Oliver Husser

  2. Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie, University of Regensburg Medical Center, Regensburg, Germany

    Andreas Holzamer & Michael Hilker

  3. Institut für Anästhesiologie, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany

    N. Patrick Mayr

  4. Klinik für Kardiologie, St. Johannes Hospital, Dortmund, Germany

    Luise Gaede, Johannes Blumenstein & Oliver Husser

  5. Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany

    Adnan Kastrati, Heribert Schunkert, Michael Joner & Christian Hengstenberg

  6. Klinische Abteilung für Kardiologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien, Vienna, Austria

    Christian Hengstenberg

Authors
  1. Teresa Trenkwalder
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  2. Costanza Pellegrini
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  3. Andreas Holzamer
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  4. Tobias Rheude
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  8. Albert M. Kasel
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  9. Luise Gaede
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  10. Johannes Blumenstein
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  13. Michael Joner
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  14. Michael Hilker
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  15. Christian Hengstenberg
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  16. Oliver Husser
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Correspondence to Oliver Husser.

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Trenkwalder, T., Pellegrini, C., Holzamer, A. et al. Prophylactic ECMO during TAVI in patients with depressed left ventricular ejection fraction. Clin Res Cardiol 108, 366–374 (2019). https://doi.org/10.1007/s00392-018-1364-6

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  • DOI: https://doi.org/10.1007/s00392-018-1364-6

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