Perioperative Predictors Of Early Mortality Following Transcatheter Aortic Valve Implantation
Takayuki Kawashima, Tomoyuki Wada, Takashi Shuto, Kunio Yufu, Tomoko Fukuda, Shuichiro Yamauchi, Naohiko Takahashi, Shinji Miyamoto.
Oita University Hospital, Yufu, Japan.
BACKGROUND: Transcatheter aortic valve implantation (TAVI) has become the gold standard treatment for high surgical risk patients with aortic stenosis (AS), and its indications are expanding. On the other hand, early mortality has also been experienced. We retrospectively investigated perioperative predictors of early mortality within 1 year after TAVI.METHODS: From March 2013 to December 2021, 233 patients underwent TAVI at our institution. Four patients of procedural failure and one patient of cancer death were excluded from the analysis. Mortality within 1 year after TAVI was defined as early mortality. Predictors of early mortality were evaluated using clinical variables including patient and procedural characteristics.RESULTS: Early mortality was 5.3 % (n = 12). Although one patient died in hospital, there was no death within 30 days after TAVI. On univariate analysis, larger left ventricular end-diastolic diameter (p = 0.026), prior cardiac surgery (p = 0.012), low flow low gradient AS (p = 0.034), emergent use of extracorporeal membrane oxygenation (ECMO) during TAVI (p < 0.0001) were associated with early mortality, although age, comorbidity, frailty scale, prophylactic use of ECMO was not associated. Multivariate analysis revealed emergent use of ECMO was an independent predictor of early mortality following TAVI (odds ratio 13.14; 95% confidence interval 2.156 - 80.08, p = 0.005). CONCLUSIONS: Emergent use of ECMO was an independent predictor of early mortality within 1 year after TAVI. Because intraoperative hemodynamic disruption directly affects patient prognosis, ECMO should be used prophylactically without hesitation in high-risk patients.
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