Outcomes of Emergency Transcatheter Aortic Valve Replacement.
Acute Kidney Injury
/ mortality
Aged
Angina, Unstable
/ surgery
Aortic Valve Insufficiency
/ surgery
Aortic Valve Stenosis
/ surgery
Cardiopulmonary Resuscitation
Emergencies
Extracorporeal Membrane Oxygenation
Female
Heart Failure
/ surgery
Hospital Mortality
Humans
Intraoperative Period
Male
Pulsatile Flow
Renal Dialysis
/ mortality
Respiratory Insufficiency
/ surgery
Shock, Cardiogenic
/ surgery
Tachycardia, Ventricular
/ surgery
Transcatheter Aortic Valve Replacement
/ mortality
Washington
/ epidemiology
Journal
Journal of interventional cardiology
ISSN: 1540-8183
Titre abrégé: J Interv Cardiol
Pays: United States
ID NLM: 8907826
Informations de publication
Date de publication:
2019
2019
Historique:
received:
16
06
2019
accepted:
26
08
2019
entrez:
29
11
2019
pubmed:
30
11
2019
medline:
2
4
2020
Statut:
epublish
Résumé
To identify outcomes of patients undergoing emergency transcatheter aortic valve replacement (TAVR) and determine predictors of in-hospital mortality. Emergency TAVR has emerged as a viable treatment strategy for patients with decompensated severe aortic stenosis and/or regurgitation; however, data on patients undergoing emergency TAVR are limited. All emergency TAVR procedures were identified from a single tertiary academic center between January 2015 and August 2018. 31 patients underwent emergency TAVR due to cardiogenic shock (26 patients), electrical instability with incessant ventricular tachycardia (2 patients), severe refractory angina (2 patients), and decompensated heart failure with hypoxemic respiratory failure requiring mechanical ventilation (1 patient). Mechanical circulatory support (MCS) was used in 16 (51.6%). MCS initiation occurred immediately prior to TAVR in 10 patients and placed post-TAVR in 6 patients. 6 patients died before hospital discharge (in-hospital mortality 19.4%). 1-year and 2-year survival rates were 61.0% and 55.9%, respectively. Univariate predictors of in-hospital mortality were preprocedural pulmonary artery pulsatility index (PAPi) ≤1.8 (66.7% vs. 20.0%, Emergency TAVR in extreme risk patients with acute decompensated heart failure or cardiogenic shock secondary to severe aortic valve disease is associated with high in-hospital mortality rates. Careful patient selection taking into account right heart function, assessed by PAPi, and early utilization of MCS may improve survival following emergency TAVR.
Sections du résumé
OBJECTIVE
OBJECTIVE
To identify outcomes of patients undergoing emergency transcatheter aortic valve replacement (TAVR) and determine predictors of in-hospital mortality.
BACKGROUND
BACKGROUND
Emergency TAVR has emerged as a viable treatment strategy for patients with decompensated severe aortic stenosis and/or regurgitation; however, data on patients undergoing emergency TAVR are limited.
METHODS
METHODS
All emergency TAVR procedures were identified from a single tertiary academic center between January 2015 and August 2018.
RESULTS
RESULTS
31 patients underwent emergency TAVR due to cardiogenic shock (26 patients), electrical instability with incessant ventricular tachycardia (2 patients), severe refractory angina (2 patients), and decompensated heart failure with hypoxemic respiratory failure requiring mechanical ventilation (1 patient). Mechanical circulatory support (MCS) was used in 16 (51.6%). MCS initiation occurred immediately prior to TAVR in 10 patients and placed post-TAVR in 6 patients. 6 patients died before hospital discharge (in-hospital mortality 19.4%). 1-year and 2-year survival rates were 61.0% and 55.9%, respectively. Univariate predictors of in-hospital mortality were preprocedural pulmonary artery pulsatility index (PAPi) ≤1.8 (66.7% vs. 20.0%,
CONCLUSION
CONCLUSIONS
Emergency TAVR in extreme risk patients with acute decompensated heart failure or cardiogenic shock secondary to severe aortic valve disease is associated with high in-hospital mortality rates. Careful patient selection taking into account right heart function, assessed by PAPi, and early utilization of MCS may improve survival following emergency TAVR.
Identifiants
pubmed: 31777471
doi: 10.1155/2019/7598581
pmc: PMC6875395
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
7598581Informations de copyright
Copyright © 2019 Hans Huang et al.
Déclaration de conflit d'intérêts
The authors declare that there are no conflicts of interest regarding the publication of this paper.
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