Cardiopulmonary bypass and intra-aortic balloon pump use is associated with higher short and long term mortality after transcatheter aortic valve replacement: a PARTNER trial substudy. Catheter Cardiovasc Interv 2015 Aug;86(2):316-22
Date
12/30/2014Pubmed ID
25546704DOI
10.1002/ccd.25776Scopus ID
2-s2.0-84937522564 (requires institutional sign-in at Scopus site) 30 CitationsAbstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) with the balloon-expandable Sapien transcatheter heart valve improves survival compared to standard therapy in patients with severe aortic stenosis (AS) and is noninferior to surgical aortic valve replacement (AVR) in patients at high operative risk. Nonetheless, a significant proportion of patients may require pre-emptive or emergent support with cardiopulmonary bypass (CPB) and/or intra-aortic balloon pump (IABP) during TAVR due to pre-existing comorbid conditions or as a result of procedural complications.
OBJECTIVES: We hypothesized that patients who required CPB or IABP would have increased periprocedural complications and reduced long-term survival. In addition, we sought to determine whether preprocedural variables could predict the need for CPB and IABP.
METHODS: The study population included 2,525 patients in the PARTNER Trial (Cohort A and B) and the continuing access registry (CAR). Patients that received CPB or IABP were compared to patients that did not receive either, and then further divided into those that received support pre-TAVR and those that were placed on support emergently.
RESULTS: One-hundred sixty-three patients (6.5%) were placed on CPB and/or IABP. The use of CPB or IABP was associated with higher 1 year mortality (49.1% vs. 21.6%, Pā<ā0.001). In multivariable analysis, utilization of CPB or IABP was an independent predictor of 30 day (HR 6.95) and 1-year (HR 2.56) mortality. Although mortality was highest in emergent cases, mortality was also greater in planned CPB and IABP cases compared with non-CPB/IABP cases (53.3% and 40.3% vs. 21.6%, Pā<ā0.001).
CONCLUSIONS: These findings indicate that CPB and IABP use in TAVR portends a poor prognosis and its utilization, particularly in the setting of pre-emptive use, needs reconsideration.
Author List
Shreenivas SS, Lilly SM, Szeto WY, Desai N, Anwaruddin S, Bavaria JE, Hudock KM, Thourani VH, Makkar R, Pichard A, Webb J, Dewey T, Kapadia S, Suri RM, Xu K, Leon MB, Herrmann HCAuthor
Saif Anwaruddin MD Associate Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Aortic Valve
Aortic Valve Stenosis
Cardiac Catheterization
Cardiopulmonary Bypass
Chi-Square Distribution
Comorbidity
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Humans
Intra-Aortic Balloon Pumping
Kaplan-Meier Estimate
Male
Multivariate Analysis
Proportional Hazards Models
Prosthesis Design
Registries
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
United States