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Hemodynamic support with Impella ventricular assist device in patients undergoing TAVI: A single center experience
Author(s) -
Almalla Mohammad,
Kersten Alexander,
Altiok Ertunc,
Marx Nikolaus,
Schröder Jörg W.
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28375
Subject(s) - impella , medicine , cardiogenic shock , cardiology , hemodynamics , clinical endpoint , stroke (engine) , stenosis , ventricular assist device , surgery , myocardial infarction , heart failure , clinical trial , mechanical engineering , engineering
Background Transcatheter aortic valve implantation (TAVI) has become a well‐established therapeutic option for patients with severe aortic stenosis (AS) at high to intermediate surgical risk. Although TAVI is associated with low mortality of 1.2–6.5%, cardiogenic shock (CS) as a peri‐interventional complication remains a challenging problem with very high morbidity and mortality. Aim This study evaluated the clinical outcome of the use of Impella ventricular assist device in patients undergoing TAVI. Methods Between 11/2015 and 08/2018, all patients undergoing TAVI requiring temporary circulatory during the same index hospitalization were included. Primary endpoint was 30‐day all‐cause mortality. Secondary endpoints were peri‐interventional mortality and 30‐day stroke rate. Results Of the 390 patients undergoing TAVI, 13 (3%) required hemodynamic support with an Impella device. Of these, 3 (23%) underwent protected high‐risk PCI before TAVI and 10 patients (77%) needed emergency periprocedural hemodynamic support due to cardiogenic shock. Mortality at 30 days was 0% in Impella‐protected PCI and 40% with Impella use for periprocedural CS. No stroke occurred in the cohort up to 30 days. Insertion of the Impella device in the setting of TAVI was fast with a mean insertion time of 10 min. Eight patients (80%) in the periprocedural CS group required cardiopulmonary resuscitation prior to Impella use. There was only one device‐related complication. Conclusions Temporary hemodynamic support with the Impella device in patients with severe aortic valve stenosis or in CS secondary to complicated TAVI was technically doable and allowed stabilization and treatment of salvageable patients.