Zusammenfassung
BackgroundThis 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).MethodsOut of 1490 patients undergoing TAVI at two centers (2010-2015), 222 patients had dLVEF (40%). Of these, 21 patients (10%) underwent TAVI with ...
Zusammenfassung
BackgroundThis 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).MethodsOut 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.ResultsIn 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).Conclusionp id=Par4In patients with dLVEF undergoing TAVI, periprocedural pECMO support does not seem to improve patient outcome.
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