Unplanned mechanical circulatory support during TAVR was associated with significantly worse outcomes, including higher rates of cardiac arrest (37% vs 1%) and surgical conversion (18% vs 1%).
Does unplanned temporary mechanical circulatory support as hemodynamic rescue worsen outcomes in adult patients undergoing TAVR?
Unplanned temporary mechanical circulatory support during TAVR is a rare event (0.57%) but is associated with catastrophic outcomes, including a 37% rate of cardiac arrest and significantly increased 30-day mortality.
Absolute Event Rate: 0% vs 0%
Background/Objectives: Acute hemodynamic collapse is a rare but deadly complication of transcatheter aortic valve replacement (TAVR) that can require temporary mechanical circulatory support (tMCS). Using a statewide collaborative, we conducted a focused analysis on the incidence and outcomes associated with the use of tMCS during TAVR as hemodynamic rescue. Methods: We identified adult patients who underwent TAVR between September 2012 and September 2024 within the statewide collaborative and stratified them based on if tMCS was needed. Baseline patient characteristics and risk factors associated with tMCS use were analyzed as well as the impact of tMCS on outcomes. Results: We identified 7735 patients who underwent TAVR. A total of 44 (0.57%) patients required tMCS. Patients requiring tMCS were more likely to have histories that included diabetes, concurrent mitral regurgitation, prior MI, or NYHA class III or IV. These patients also experienced more emergent procedures and were more likely to require inotropic support. Patients experienced significantly worse outcomes following tMCS rescue during TAVR, with 18% requiring conversion to surgical approach (vs. 1%, p < 0.001) and 37% of tMCS patients experiencing cardiac arrest, compared to 1% of those who did not need tMCS (p < 0.001). Thirty-day mortality was worse for patients requiring tMCS (p < 0.001). MCS usage was independently associated with the need for further procedures. Conclusions: Unplanned, emergent tMCS during TAVR as hemodynamic rescue represents significant risk of complications and should be utilized judiciously in cases of acute hemodynamic collapse.
Keller et al. (Fri,) reported a other. Unplanned mechanical circulatory support during TAVR was associated with significantly worse outcomes, including higher rates of cardiac arrest (37% vs 1%) and surgical conversion (18% vs 1%).