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Temporary Mechanical Circulatory Support for Transcatheter Aortic Valve Replacement.

Benjamin L Shou1, Arjun Verma2, Isabella S Florissi1

  • 1Division of Cardiac Surgery, Department of Surgery, Heart and Vascular Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.

The Journal of Surgical Research
|August 29, 2022
PubMed
Summary

Temporary mechanical circulatory support (tMCS) use during transcatheter aortic valve replacement (TAVR) has declined. However, tMCS remains linked to significantly higher mortality and increased healthcare resource utilization.

Keywords:
National inpatient sampleTemporary mechanical circulatory supportTranscatheter aortic valve replacement

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Device Technology

Background:

  • Transcatheter aortic valve replacement (TAVR) is a growing procedure for aortic stenosis.
  • Temporary mechanical circulatory support (tMCS) may be required during TAVR for hemodynamic instability.
  • Understanding tMCS utilization patterns and outcomes in TAVR is crucial for patient management.

Purpose of the Study:

  • To characterize the utilization of temporary mechanical circulatory support (tMCS) in patients undergoing transcatheter aortic valve replacement (TAVR).
  • To evaluate temporal trends in tMCS use during TAVR.
  • To identify factors associated with tMCS use and its impact on in-hospital outcomes.

Main Methods:

  • Analysis of the 2012-2018 National Inpatient Sample for adult patients undergoing isolated TAVR.
  • Definition of tMCS as extracorporeal membrane oxygenation, percutaneous ventricular assist device, or intra-aortic balloon pump during index hospitalization.
  • Utilized Cuzick's test for temporal trends and multivariable logistic regression for outcome analysis.

Main Results:

  • 1.4% of 215,925 TAVR patients (3,085) required tMCS, with intra-aortic balloon pump being the most common modality.
  • Annual tMCS utilization decreased from 3% in 2012 to 1% in 2018 (P-trend < 0.01).
  • tMCS was associated with a 23-fold increased in-hospital mortality (31.8%), longer length of stay, and higher costs.

Conclusions:

  • While tMCS use during TAVR has decreased, it is still associated with a substantial increase in mortality.
  • Factors such as nonelective admission and comorbidities predict the need for tMCS.
  • tMCS in TAVR patients presents a significant clinical and resource burden.