Faculty Collaboration Database

Temporary Mechanical Circulatory Support for Transcatheter Aortic Valve Replacement. J Surg Res 2022 Dec;280:363-370

Date

08/30/2022

Pubmed ID

36037613

DOI

10.1016/j.jss.2022.07.034

Scopus ID

2-s2.0-85136583238 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

INTRODUCTION: This study aimed to characterize the use of temporary mechanical circulatory support (tMCS) among patients undergoing transcatheter aortic valve replacement (TAVR) using a nationally representative database.

MATERIALS AND METHODS: The 2012-2018 National Inpatient Sample was queried for adult patients who underwent isolated TAVR. The tMCS group was comprised of those who required extracorporeal membrane oxygenation, percutaneous ventricular assist device, or intra-aortic balloon pump during index hospitalization. We evaluated temporal trends in the utilization of tMCS using Cuzick's test. Furthermore, a multivariable logistic regression was used to identify factors associated with tMCS use and its impact on in-hospital mortality, selected complications, and nonhome discharge.

RESULTS: Of an estimated 215,925 patients who underwent TAVR, 3085 (1.4%) required tMCS during their hospital course. The most common modality of tMCS was intra-aortic balloon pump (49%), followed by extracorporeal membrane oxygenation (27%) then percutaneous ventricular assist device (18%). Seven percent of tMCS patients were supported by > 1 device. The annual incidence of tMCS usage decreased over the study period, from 3% in 2012 to 1% in 2018 (P-trend < 0.01). Nonelective admission, congestive heart failure, coagulopathy, and liver disease were strong independent predictors of requiring tMCS. Patients requiring tMCS had a 31.8% in-hospital mortality rate (adjusted odds ratio = 23, 95% confidence interval 18.5-28.5), longer length of stay (9 d versus 3, P < 0.001), and higher costs ($84,600 versus $48,100, P < 0.001) than those who did not.

CONCLUSIONS: The use of tMCS during TAVR has decreased over time but remains associated with a 23-fold increased mortality rate and significant clinical and resource utilization burden.

Author List

Shou BL, Verma A, Florissi IS, Schena S, Benharash P, Choi CW

Author

Stefano Schena MD, PhD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aortic Valve
Aortic Valve Stenosis
Hospital Mortality
Humans
Length of Stay
Risk Factors
Time Factors
Transcatheter Aortic Valve Replacement
Treatment Outcome