Periprocedural cardiopulmonary bypass or venoarterial extracorporeal membrane oxygenation during transcatheter aortic valve replacement: A systematic review

Saraschandra Vallabhajosyula, Sri Harsha Patlolla, Harigopal Sandhyavenu, Saarwaani Vallabhajosyula, Gregory W. Barsness, Shannon M Dunlay, Kevin L. Greason, David Holmes, Mackram Eleid

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background—There are limited data on the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) or cardiopulmonary bypass (CPB) to provide hemodynamic support periprocedurally during transcatheter aortic valve replacement. This study sought to evaluate patients receiving transcatheter aortic valve replacement with concomitant use of CPB/VA-ECMO. Methods and Results—We systematically reviewed the published literature from 2000 to 2018 for studies evaluating adult patients requiring CPB/VA-ECMO periprocedurally during transcatheter aortic valve replacement. Studies reporting short-term and long-term mortality were included. Given the significant methodological and statistical differences between published studies, meta-analysis of the association of CPB/VA-ECMO with mortality was not performed. Of the 537 studies identified, 9 studies representing 5191 patients met our inclusion criteria. Median ages were between 75 and 87 years with 33% to 75% male patients. Where reported, the Edwards SAPIEN™ transcatheter heart valve was the most frequently used. A total of 203 (3.9%) patients received periprocedural hemodynamic support with CPB/VA-ECMO. Common indications for CPB/VA-ECMO included left ventricular or aortic annular rupture, rapid hemodynamic deterioration, aortic regurgitation, cardiac arrest, and left main coronary artery obstruction. The use of CPB/VA-ECMO was predominantly an emergent strategy and was used for durations of 1 to 2 hours. Short-term mortality (in-hospital and 30-day) was 29.8%, and 1-year mortality was 52.4%. Major complications such as bleeding, vascular injury, tamponade, stroke, and renal failure were noted in 10% to 50% of patients. Conclusions—CPB/VA-ECMO was used in 4% in the early experience of patients undergoing transcatheter aortic valve replacement, most commonly for periprocedural complications. There are limited data on preprocedural planned use of VA-ECMO, and the characteristics of this population remain poorly defined.

Original languageEnglish (US)
Article numbere009608
JournalJournal of the American Heart Association
Volume7
Issue number14
DOIs
StatePublished - Jul 1 2018

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Extracorporeal Membrane Oxygenation
Cardiopulmonary Bypass
Hemodynamics
Mortality
Transcatheter Aortic Valve Replacement
Aortic Rupture
Aortic Valve Insufficiency
Vascular System Injuries
Heart Valves
Population Characteristics
Hospital Mortality
Heart Arrest
Renal Insufficiency
Meta-Analysis
Coronary Vessels
Stroke
Hemorrhage

Keywords

  • Cardiogenic shock
  • Cardiopulmonary bypass
  • Critical care
  • Mechanical circulatory support
  • Transcatheter valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Periprocedural cardiopulmonary bypass or venoarterial extracorporeal membrane oxygenation during transcatheter aortic valve replacement : A systematic review. / Vallabhajosyula, Saraschandra; Patlolla, Sri Harsha; Sandhyavenu, Harigopal; Vallabhajosyula, Saarwaani; Barsness, Gregory W.; Dunlay, Shannon M; Greason, Kevin L.; Holmes, David; Eleid, Mackram.

In: Journal of the American Heart Association, Vol. 7, No. 14, e009608, 01.07.2018.

Research output: Contribution to journalArticle

Vallabhajosyula, Saraschandra ; Patlolla, Sri Harsha ; Sandhyavenu, Harigopal ; Vallabhajosyula, Saarwaani ; Barsness, Gregory W. ; Dunlay, Shannon M ; Greason, Kevin L. ; Holmes, David ; Eleid, Mackram. / Periprocedural cardiopulmonary bypass or venoarterial extracorporeal membrane oxygenation during transcatheter aortic valve replacement : A systematic review. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 14.
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abstract = "Background—There are limited data on the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) or cardiopulmonary bypass (CPB) to provide hemodynamic support periprocedurally during transcatheter aortic valve replacement. This study sought to evaluate patients receiving transcatheter aortic valve replacement with concomitant use of CPB/VA-ECMO. Methods and Results—We systematically reviewed the published literature from 2000 to 2018 for studies evaluating adult patients requiring CPB/VA-ECMO periprocedurally during transcatheter aortic valve replacement. Studies reporting short-term and long-term mortality were included. Given the significant methodological and statistical differences between published studies, meta-analysis of the association of CPB/VA-ECMO with mortality was not performed. Of the 537 studies identified, 9 studies representing 5191 patients met our inclusion criteria. Median ages were between 75 and 87 years with 33{\%} to 75{\%} male patients. Where reported, the Edwards SAPIEN™ transcatheter heart valve was the most frequently used. A total of 203 (3.9{\%}) patients received periprocedural hemodynamic support with CPB/VA-ECMO. Common indications for CPB/VA-ECMO included left ventricular or aortic annular rupture, rapid hemodynamic deterioration, aortic regurgitation, cardiac arrest, and left main coronary artery obstruction. The use of CPB/VA-ECMO was predominantly an emergent strategy and was used for durations of 1 to 2 hours. Short-term mortality (in-hospital and 30-day) was 29.8{\%}, and 1-year mortality was 52.4{\%}. Major complications such as bleeding, vascular injury, tamponade, stroke, and renal failure were noted in 10{\%} to 50{\%} of patients. Conclusions—CPB/VA-ECMO was used in 4{\%} in the early experience of patients undergoing transcatheter aortic valve replacement, most commonly for periprocedural complications. There are limited data on preprocedural planned use of VA-ECMO, and the characteristics of this population remain poorly defined.",
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author = "Saraschandra Vallabhajosyula and Patlolla, {Sri Harsha} and Harigopal Sandhyavenu and Saarwaani Vallabhajosyula and Barsness, {Gregory W.} and Dunlay, {Shannon M} and Greason, {Kevin L.} and David Holmes and Mackram Eleid",
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T2 - A systematic review

AU - Vallabhajosyula, Saraschandra

AU - Patlolla, Sri Harsha

AU - Sandhyavenu, Harigopal

AU - Vallabhajosyula, Saarwaani

AU - Barsness, Gregory W.

AU - Dunlay, Shannon M

AU - Greason, Kevin L.

AU - Holmes, David

AU - Eleid, Mackram

PY - 2018/7/1

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N2 - Background—There are limited data on the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) or cardiopulmonary bypass (CPB) to provide hemodynamic support periprocedurally during transcatheter aortic valve replacement. This study sought to evaluate patients receiving transcatheter aortic valve replacement with concomitant use of CPB/VA-ECMO. Methods and Results—We systematically reviewed the published literature from 2000 to 2018 for studies evaluating adult patients requiring CPB/VA-ECMO periprocedurally during transcatheter aortic valve replacement. Studies reporting short-term and long-term mortality were included. Given the significant methodological and statistical differences between published studies, meta-analysis of the association of CPB/VA-ECMO with mortality was not performed. Of the 537 studies identified, 9 studies representing 5191 patients met our inclusion criteria. Median ages were between 75 and 87 years with 33% to 75% male patients. Where reported, the Edwards SAPIEN™ transcatheter heart valve was the most frequently used. A total of 203 (3.9%) patients received periprocedural hemodynamic support with CPB/VA-ECMO. Common indications for CPB/VA-ECMO included left ventricular or aortic annular rupture, rapid hemodynamic deterioration, aortic regurgitation, cardiac arrest, and left main coronary artery obstruction. The use of CPB/VA-ECMO was predominantly an emergent strategy and was used for durations of 1 to 2 hours. Short-term mortality (in-hospital and 30-day) was 29.8%, and 1-year mortality was 52.4%. Major complications such as bleeding, vascular injury, tamponade, stroke, and renal failure were noted in 10% to 50% of patients. Conclusions—CPB/VA-ECMO was used in 4% in the early experience of patients undergoing transcatheter aortic valve replacement, most commonly for periprocedural complications. There are limited data on preprocedural planned use of VA-ECMO, and the characteristics of this population remain poorly defined.

AB - Background—There are limited data on the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) or cardiopulmonary bypass (CPB) to provide hemodynamic support periprocedurally during transcatheter aortic valve replacement. This study sought to evaluate patients receiving transcatheter aortic valve replacement with concomitant use of CPB/VA-ECMO. Methods and Results—We systematically reviewed the published literature from 2000 to 2018 for studies evaluating adult patients requiring CPB/VA-ECMO periprocedurally during transcatheter aortic valve replacement. Studies reporting short-term and long-term mortality were included. Given the significant methodological and statistical differences between published studies, meta-analysis of the association of CPB/VA-ECMO with mortality was not performed. Of the 537 studies identified, 9 studies representing 5191 patients met our inclusion criteria. Median ages were between 75 and 87 years with 33% to 75% male patients. Where reported, the Edwards SAPIEN™ transcatheter heart valve was the most frequently used. A total of 203 (3.9%) patients received periprocedural hemodynamic support with CPB/VA-ECMO. Common indications for CPB/VA-ECMO included left ventricular or aortic annular rupture, rapid hemodynamic deterioration, aortic regurgitation, cardiac arrest, and left main coronary artery obstruction. The use of CPB/VA-ECMO was predominantly an emergent strategy and was used for durations of 1 to 2 hours. Short-term mortality (in-hospital and 30-day) was 29.8%, and 1-year mortality was 52.4%. Major complications such as bleeding, vascular injury, tamponade, stroke, and renal failure were noted in 10% to 50% of patients. Conclusions—CPB/VA-ECMO was used in 4% in the early experience of patients undergoing transcatheter aortic valve replacement, most commonly for periprocedural complications. There are limited data on preprocedural planned use of VA-ECMO, and the characteristics of this population remain poorly defined.

KW - Cardiogenic shock

KW - Cardiopulmonary bypass

KW - Critical care

KW - Mechanical circulatory support

KW - Transcatheter valve implantation

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