Author + information
- Pradeep Yadav1,
- Vikas Singh2,
- Marvin Eng3,
- Francisco MacEdo4,
- Guilherme Silva5,
- Andrew Rassi6,
- Rodrigo Mendirichaga7,
- Carlos Alfonso8,
- Mauricio Cohen9,
- Igor Palacios10 and
- William O'Neill11
- 1Penn State University, Hershey, Pennsylvania, United States
- 2Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
- 3University Clinic of Munich
- 4Universitätsklinikum Jena, Germany
- 5Texas Heart Institute, Houston, Texas, United States
- 6Kaiser Permanente San Francisco Medical Center, San Francisco, California, United States
- 7University of Miami Miller School of Medicine, Miami, Florida, United States
- 8University of Miami Miller School of Medicine, Miami, Florida, United States
- 9University of Miami Hospital, Miami, Florida, United States
- 10Massachusetts General Hospital, Boston, Massachusetts, United States
- 11Henry Ford Hospital, Detroit, Michigan, United States
Severe aortic stenosis (AS) with left ventricular dysfunction patients are at risk of adverse events when undergoing balloon aortic valvuloplasty (BAV). Hemodynamic support is often used as a “bailout” after the BAV; however, smaller single center reports have suggested its role on elective basis. The aim of this study is to compare outcomes in patients with severe AS and severe LV dysfunction who underwent BAV +/- PCI with use of Impella (Abiomed, Danvers, MA) as elective (upfront) vs emergent (bailout) strategy.
Patients were identified from cVAD registry an on-going multicenter voluntary registry open to all sites in the North America and Europe that have used the Impella device for all indications in more than 10 patients.
Of total 118 patients (mean age 80.58±9.06 years), majority (73%) had Impella placed electively prior to BAV, while 27% required Impella emergently after BAV. The two groups were similar except the elective group more commonly had coronary artery disease (82.7% vs 63.3%, p = 0.041), had lower LV ejection fraction (24.8% vs 33.0 %, p = 0.020). The emergent group had higher STS mortality score (31.8% vs 14.8%, p = 0.004). Elective placement of Impella was associated with significantly better 1-year survival when compared to emergency placement of the device (58% vs 30%, p=0.003) (figure 1), primarily driven by better early survival.
This largest series suggests high risk AS patients with concomitant LV dysfunction undergoing BAV have significantly better survival when hemodynamic support is used upfront, electively (rather than emergent, bailout).
STRUCTURAL: Valvular Disease: Aortic