Gerfer, Stephen ORCID: 0000-0002-6568-6766, Kuhn, Elmar W. ORCID: 0000-0001-6301-7422, Gablac, Hannah, Ivanov, Borko, Djordjevic, Ilija ORCID: 0000-0002-5810-8626, Mauri, Victor, Adam, Matti, Mader, Navid, Baldus, Stephan, Eghbalzadeh, Kaveh and Wahlers, Thorsten C. W. (2023). Outcomes and Characteristics of Patients with Intraprocedural Cardiopulmonary Resuscitation during TAVR. Thorac. Cardiovasc. Surg., 71 (2). S. 101 - 107. STUTTGART: GEORG THIEME VERLAG KG. ISSN 1439-1902

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Abstract

Background Transcatheter aortic valve replacement (TAVR) has become an established alternative to surgical aortic valve replacement (AVR) for higher risk patients. Periprocedural TAVR complications decreased with a growing expertise of implanters. Yet, TAVR can be accompanied by life-threatening adverse events such as intraprocedural cardiopulmonary resuscitation (CPR). This study retrospectively analyzed predictors and outcomes in a cohort of patients from a high-volume center undergoing periprocedural CPR during TAVR. Methods A total of 729 patients undergoing TAVR, including 59 with intraprocedural CPR, were analyzed with respect to peri- and postprocedural outcomes. Results Patients undergoing CPR showed a significantly lower left ventricular ejection fraction (LVEF) and lower baseline transvalvular mean and peak pressure gradients. The systolic blood pressure measured directly preoperatively was significantly lower in the CPR cohort. CPR patients were in a higher need for intraprocedural defibrillation, heart-lung circulatory support, and conversion to open heart surgery. Further, they showed a higher incidence of atrioventricular block grade III , valve malpositioning, and pericardial tamponade. The in-hospital mortality was significantly higher after intraprocedural CPR, accompanied by a higher incidence of disabling stroke, new pacemaker implantation, more red blood cell transfusion, and longer stay in intensive care unit. Conclusion Impaired preoperative LVEF and instable hemodynamics before valve deployment are independent risk factors for CPR and are associated with compromised outcomes. Heart rhythm disturbances, malpositioning of the prosthesis, and pericardial tamponade are main causes of the high mortality of 17% reported in the CPR group. Nevertheless, mechanical circulatory support and conversion to open heart surgery reduce mortality rates of CPR patients.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Gerfer, StephenUNSPECIFIEDorcid.org/0000-0002-6568-6766UNSPECIFIED
Kuhn, Elmar W.UNSPECIFIEDorcid.org/0000-0001-6301-7422UNSPECIFIED
Gablac, HannahUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ivanov, BorkoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Djordjevic, IlijaUNSPECIFIEDorcid.org/0000-0002-5810-8626UNSPECIFIED
Mauri, VictorUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Adam, MattiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mader, NavidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Baldus, StephanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Eghbalzadeh, KavehUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wahlers, Thorsten C. W.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-666458
DOI: 10.1055/s-0042-1750304
Journal or Publication Title: Thorac. Cardiovasc. Surg.
Volume: 71
Number: 2
Page Range: S. 101 - 107
Date: 2023
Publisher: GEORG THIEME VERLAG KG
Place of Publication: STUTTGART
ISSN: 1439-1902
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
Cardiac & Cardiovascular Systems; Respiratory System; SurgeryMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/66645

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