Emergency and prophylactic use of miniaturized veno‐arterial extracorporeal membrane oxygenation in transcatheter aortic valve implantation

Abstract

Objectives To report our center's experience using veno‐arterial extracorporeal membrane oxygenation (vaECMO) in transcatheter aortic valve implantation (TAVI). Background In TAVI, short‐term mortality closely relates to life threatening procedural complications. VaECMO can be used to stabilize the patient in emergency situations. However, for the prophylactic use of vaECMO in very high‐risk patients undergoing TAVI there is no experience. Methods From January 2009 to August 2011, we performed 131 TAVI. Emergency vaECMO was required in 8 cases (7%): ventricular perforation (n = 3), hemodynamic instability/cardiogenic shock (n = 4), hemodynamic deterioration due to ventricular tachycardia (n = 1). Since August 2011, during 83 procedures, prophylactic vaECMO was systematically used in very high‐risk patients (n = 9, 11%) and emergency ECMO in one case (1%) due to ventricular perforation. Results Median logistic EuroScore in prophylactic vaECMO patients was considerably higher as compared to the remaining TAVI population (30% vs. 15%, P = 0.0003) while in patients with emergency vaECMO it was comparable (18% vs. 15%, P = 0.08). Comparing prophylactic to emergency vaECMO, procedural success and 30‐day mortality were 100% vs. 44% (P = 0.03) and 0% vs. 44% (P = 0.02), respectively. Major vascular complications and rate of life threatening bleeding did not differ between both groups (11% vs. 11%, P = 0.99 and 11% vs. 33%, P = 0.3) and were not vaECMO‐related. Conclusions Life‐threatening complications during TAVI can be managed using emergency vaECMO but mortality remains high. The use of prophylactic vaECMO in very high‐risk patients is safe and may be advocated in selected cases.