Prophylactic ECMO during TAVI in patients with depressed left ventricular ejection fraction

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Critical Care Medicine

Background:

• Transcatheter aortic valve implantation (TAVI) is increasingly used for aortic stenosis.
• Patients with depressed left ventricular ejection fraction (dLVEF) undergoing TAVI face higher risks.
• Prophylactic veno-arterial extracorporeal membrane oxygenation (pECMO) is a potential supportive strategy for high-risk TAVI patients.

Purpose of the Study:

• To evaluate the impact of periprocedural pECMO on outcomes in patients with dLVEF undergoing TAVI.
• To compare complications and mortality rates between TAVI patients with and without pECMO support.

Main Methods:

• Retrospective analysis of 1490 TAVI patients (2010-2015), identifying 222 with dLVEF (≤40%).
• Comparison of outcomes in 21 patients who received pECMO versus those who did not.
• Analysis performed on the entire cohort and a propensity-matched sub-cohort to control for confounding factors.

Main Results:

• Patients receiving pECMO had higher baseline risk scores (logEuroScore I) and worse LVEF.
• The pECMO group experienced more major bleeding and higher transfusion rates in the entire cohort.
• While 30-day mortality was higher with pECMO in the overall group, this difference was not significant after propensity matching; 1-year mortality did not differ between groups.

Conclusions:

• Periprocedural pECMO support in patients with dLVEF undergoing TAVI does not appear to improve clinical outcomes.
• The use of pECMO in this high-risk TAVI population did not demonstrate a significant benefit regarding short-term or long-term mortality.
• Further research may be needed to identify specific subgroups who might benefit from such advanced hemodynamic support during TAVI.