Cardiopulmonary bypass and intra-aortic balloon pump use is associated with higher short and long term mortality after transcatheter aortic valve replacement: a PARTNER trial substudy. 

 -  2015 
<br/><br/>Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006 
<br/><br/> BACKGROUND: Transcatheter aortic valve replacement (TAVR) with the balloon-expandable Sapien transcatheter heart valve improves survival compared to standard therapy in patients with severe aortic stenosis (AS) and is noninferior to surgical aortic valve replacement (AVR) in patients at high operative risk. Nonetheless, a significant proportion of patients may require pre-emptive or emergent support with cardiopulmonary bypass (CPB) and/or intra-aortic balloon pump (IABP) during TAVR due to pre-existing comorbid conditions or as a result of procedural complications.  CONCLUSIONS: These findings indicate that CPB and IABP use in TAVR portends a poor prognosis and its utilization, particularly in the setting of pre-emptive use, needs reconsideration.Copyright © 2015 Wiley Periodicals, Inc.  METHODS: The study population included 2,525 patients in the PARTNER Trial (Cohort A and B) and the continuing access registry (CAR). Patients that received CPB or IABP were compared to patients that did not receive either, and then further divided into those that received support pre-TAVR and those that were placed on support emergently.  OBJECTIVES: We hypothesized that patients who required CPB or IABP would have increased periprocedural complications and reduced long-term survival. In addition, we sought to determine whether preprocedural variables could predict the need for CPB and IABP.  RESULTS: One-hundred sixty-three patients (6.5%) were placed on CPB and/or IABP. The use of CPB or IABP was associated with higher 1 year mortality (49.1% vs. 21.6%, P<0.001). In multivariable analysis, utilization of CPB or IABP was an independent predictor of 30 day (HR 6.95) and 1-year (HR 2.56) mortality. Although mortality was highest in emergent cases, mortality was also greater in planned CPB and IABP cases compared with non-CPB/IABP cases (53.3% and 40.3% vs. 21.6%, P<0.001). 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>1522-1946 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Aortic Valve<br/>*Aortic Valve Stenosis/th [Therapy]<br/>*Cardiac Catheterization/mo [Mortality]<br/>*Cardiopulmonary Bypass/mo [Mortality]<br/>*Heart Valve Prosthesis Implantation/mo [Mortality]<br/>*Intra-Aortic Balloon Pumping/mo [Mortality]<br/>Aged<br/>Aged, 80 and over<br/>Aortic Valve Stenosis/di [Diagnosis]<br/>Aortic Valve Stenosis/mo [Mortality]<br/>Aortic Valve Stenosis/pp [Physiopathology]<br/>Aortic Valve/pp [Physiopathology]<br/>Cardiac Catheterization/ae [Adverse Effects]<br/>Cardiac Catheterization/is [Instrumentation]<br/>Cardiopulmonary Bypass/ae [Adverse Effects]<br/>Chi-Square Distribution<br/>Comorbidity<br/>Female<br/>Heart Valve Prosthesis<br/>Heart Valve Prosthesis Implantation/ae [Adverse Effects]<br/>Heart Valve Prosthesis Implantation/is [Instrumentation]<br/>Humans<br/>Intra-Aortic Balloon Pumping/ae [Adverse Effects]<br/>Kaplan-Meier Estimate<br/>Male<br/>Multivariate Analysis<br/>Proportional Hazards Models<br/>Prosthesis Design<br/>Registries<br/>Risk Assessment<br/>Risk Factors<br/>Severity of Illness Index<br/>Time Factors<br/>Treatment Outcome<br/>United States
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Washington Hospital Center
<br/><br/><label>Index Terms--Occupation: </label><br/>MedStar Heart Institute
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article<br/>Multicenter Study<br/>Randomized Controlled Trial