Key result
Prophylactic awake V-A ECMO during high-risk TAVR yields 0% procedural complications.
Why the study?
TAVR can result in serious intraprocedural complications requiring V-A ECMO for hemodynamic support, but outcomes with prophylactic peripheral V-A ECMO in high-risk cases required description.
Does prophylactic placement of awake peripheral V-A ECMO prevent periprocedural hemodynamic and vascular complications in patients at very high risk undergoing TAVR?
Cohort (n=27)
No
Does prophylactic placement of awake peripheral V-A ECMO prevent periprocedural hemodynamic and vascular complications in patients at very high risk undergoing TAVR?
Prophylactic awake peripheral V-A ECMO via surgical mini cut-down under conscious sedation is a feasible and safe strategy to provide temporary hemodynamic support during very high-risk TAVR without increasing vascular or bleeding complications.
Answers are grounded in this paper and cite their sources.
May support prophylactic awake peripheral V-A ECMO in very high-risk TAVR; hypothesis-generating and requires randomized trials before practice change.
INTRODUCTION: TAVR remains a complex procedure that may result in serious intraprocedural complications. In many of these circumstances, venoarterial extracorporeal membrane oxygenation (V-A ECMO) helps to manage complications, provides a hemodynamic back-up, and bridges to an emergency open heart surgery. The clinical outcomes of 27 patients who underwent prophylactic implantation of peripheral V-A ECMO (pV-A ECMO) during high-risk transcatheter aortic valve replacement (TAVR) cases are described. METHODS: From June 2012 to October 2022, 590 consecutive patients underwent TAVR at our center. Of these, 27 patients (4.5%) underwent TAVR with pV-AECMO because they were deemed very high risk for periprocedural complications and formed the study population. RESULTS: There were no pV-A ECMO, hemodynamic or TAVR implantation complications. Decannulation of the ECMO system was performed in 92.6% of cases at the end of the procedure in the hybrid-operating theatre. The mean duration of pV-A ECMO for procedure support was 51.4 ± 10.3 min. There were no ECMO-related vascular or bleeding complications. CONCLUSION: This study shows that the prophylactic placement of awake peripheral V-A ECMO provides excellent temporary cardio-circulatory and pulmonary support during very high-risk TAVR procedures.
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Lesbekov et al. (2023) conducted a cohort in Severe aortic stenosis undergoing high-risk transcatheter aortic valve replacement (TAVR) (n=27). Prophylactic awake peripheral venoarterial extracorporeal membrane oxygenation (pV-A ECMO) was evaluated on Periprocedural complications (pV-A ECMO, hemodynamic, TAVR implantation, vascular, or bleeding complications) and hospital mortality. Prophylactic awake peripheral V-A ECMO during very high-risk TAVR resulted in 0% procedural, vascular, or bleeding complications and 92.6% immediate operating-room decannulation.
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