Effect of Mechanical Circulatory Support on Mortality After Transcatheter Aortic Valve Replacement: A Landmark Analysis

Chen Yang; Yang Liu; Yu Mao; Xiaoke Shang; Fan Qiao; Jian Liu; Yenong Zhou; Mengen Zhai; Shiqiang Yu; Tao Chen; Jian Yang; Zhenxiao Jin

doi:10.1097/MAT.0000000000002313

Effect of Mechanical Circulatory Support on Mortality After Transcatheter Aortic Valve Replacement: A Landmark Analysis

ASAIO J. 2024 Sep 24. doi: 10.1097/MAT.0000000000002313. Online ahead of print.

Authors

Chen Yang¹, Yang Liu¹, Yu Mao¹, Xiaoke Shang², Fan Qiao³, Jian Liu⁴, Yenong Zhou¹, Mengen Zhai¹, Shiqiang Yu¹, Tao Chen¹, Jian Yang¹, Zhenxiao Jin¹

Affiliations

¹ From the Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China.
² Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
³ Department of Cardiothoracic Surgery, Changhai Hospital, Naval Medical University, Shanghai, China.
⁴ Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangzhou, China.

PMID: 39316612
DOI: 10.1097/MAT.0000000000002313

Abstract

A proportion of patients still need mechanical circulatory support (MCS) during the transcatheter aortic valve replacement (TAVR) because of intraoperative hemodynamic instability. However, the outcomes of patients with different MCS type during TAVR are still controversial. A total of 538 patients who underwent TAVR procedure in four centers were included. The time-related outcomes and their predictors of patients who did not have MCS (MCS-, n = 498) were compared with those who underwent emergency MCS (eMCS+, n = 18) and prophylactic MCS (pMCS+, n = 22). We evaluated the association between different MCS groups and all-cause mortality using conditional landmark analysis with Cox regression. There was a significant increase in 30-day mortality in the eMCS+ group (plog-rank < 0.001) and no significant difference in 31-day to 1-year mortality among the groups (plog-rank = 0.789). A significant improvement in the left ventricular ejection fraction was observed in the pMCS+ group at 1 year after TAVR. Emergency MCS was independently associated with 30-day mortality, as well as 1-year mortality. Prophylactic MCS showed good clinical outcomes and might be considered for high-risk patients. Further studies are needed to investigate the predictors that lead to MCS usage and long-term mortality in TAVR patients with MCS.