Percutaneous mechanical circulatory support from the collaborative multicenter Mechanical Unusual Support in TAVI (MUST) Registry.

Orvin, Katia; Perl, Leor; Landes, Uri; Dvir, Danny; Webb, John George; Stelzmüller, Marie-Elisabeth; Wisser, Wilfried; Nazif, Tamim Michael; George, Isaac; Miura, Mizuki; Taramasso, Maurizio; Pilgrim, Thomas; Fürholz, Monika; Sinning, Jan-Malte; Nickenig, Georg; Rumer, Chris; Tarantini, Giuseppe; Masiero, Giulia; Bunc, Matjas; Radsel, Peter; ... (2021). Percutaneous mechanical circulatory support from the collaborative multicenter Mechanical Unusual Support in TAVI (MUST) Registry. Catheterization and cardiovascular interventions, 98(6), E862-E869. Wiley-Blackwell 10.1002/ccd.29747

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OBJECTIVES

To evaluate the use and outcomes of percutaneous mechanical circulatory support (pMCS) utilized during transcatheter aortic valve implantation (TAVI) from high-volume centers.

METHODS AND RESULTS

Our international multicenter registry including 13 high-volume TAVI centers with 87 patients (76.5 ± 11.8 years, 63.2% men) who underwent TAVI for severe aortic stenosis and required pMCS (75.9% VA-ECMO, 19.5% Impella CP, 4.6% TandemHeart) during the procedure (prior to TAVI 39.1%, emergent rescue 50.6%, following TAVI 10.3%). The procedures were considered high-risk, with 50.6% having severe left ventricular dysfunction, 24.1% biventricular dysfunction, and 32.2% severe pulmonary hypertension. In-hospital and 1-year mortality were 27.5% and 49.4%, respectively. Patients with prophylactic hemodynamic support had lower periprocedural mortality compared to patients with rescue insertion of pMCS (log rank = 0.013) and patients who did not undergo cardiopulmonary resuscitation during the TAVI procedure had better short and long term survival (log rank <0.001 and 0.015, respectively).

CONCLUSIONS

Given the overall survival rate and low frequency of pMCS-related complications, our study results support the use of pMCS prophylactically or during the course of TAVI (bailout) in order to improve clinical outcomes in high-risk procedures or in case of acute life-threatening hemodynamic collapse.

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