Universität zu Köln

Gablac, Hannah (2023). Analyse des postoperativen Outcomes von Patienten mit intraprozeduraler Reanimation während einer transkathetergestützten Aortenklappenimplantation. PhD thesis, Universität zu Köln.

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Abstract

Background Transcatheter aortic valve replacement (TAVR) has become an estab- lished 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 intra- procedural 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 signi!cantly lower left ventricular ejection fraction (LVEF) and lower baseline transvalvular mean and peak pressure gradients. The systolic blood pressure measured directly preoperatively was signi!cantly lower in the CPR cohort. CPR patients were in a higher need for intraprocedural de!brillation, 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 signi!cantly higher after intra- procedural CPR, accompanied by a higher incidence of disabling stroke, new pacemak- er 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 consecutivelyQ6 are associated with compromised outcome. 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 conver- sion to open heart surgery reduce mortality rates of CPR patients.

Item Type:	Thesis (PhD thesis)
Creators:	Creators Email ORCID ORCID Put Code Gablac, Hannah hannah@gablac.de UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-718543
Date:	2023
Language:	German
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Chirurgie > Klinik und Poliklinik für Herz- und Thoraxchirurgie
Subjects:	Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language Transkathetergestützter Aortenklappenersatz German Reanimation German postoperativer Outcome TAVI German
Date of oral exam:	15 November 2023
Referee:	Name Academic Title Eghbazadeh, Kaveh Privatdozent Böttiger, Bernd Universitätsprofessor
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/71854