Abstract
Objectives: Elective use of normothermic cardiopulmonary bypass (CPB) may reduce the risk of a transcatheter aortic valve implantation (TAVI) procedure in selected high-risk TAVI patients. Methods: Between April 2008 and March 2013, 1040 consecutive patients underwent TAVI. Elective normothermic femoro-femoral CPB was used in 4.4% of patients (n = 46, 26 men and 20 women; mean age 73 ± 13 [range 34-90] years). The EuroSCORE I was 64 ± 25%, the EuroSCORE II was 42 ± 24% and the STS PROM score was 32 ± 25%. The mean left ventricular ejection fraction (LVEF) was 26 ± 16% (range 10-74). Results: The technical success rate was 100%. Duration of cardiopulmonary bypass was 68 ± 102 min (range 6-628). In 13 patients with poor RVEF or LVEF (mean LVEF 18 ± 5% [range 10-30]), CPB was used to prevent haemodynamic instability during valve deployment and to eliminate the consequences of possible ventricular fibrillation. Additionally, it was used for recovery of the unloaded heart in 25 patients with cardiogenic shock. The 30-day mortality was 13% and one-year survival was 52%. Conclusions: The use of preoperatively planned CPB enhances the safety of the TAVI procedure in patients with severely reduced heart function or in cardiogenic shock.
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