Elective femoro-femoral cardiopulmonary bypass during transcatheter aortic valve implantation: A useful tool

Objective: Transcatheter aortic valve implantation is a new method to treat high-risk patients with aortic valve stenosis. The operative risk can be reduced, especially in patients with severely reduced left ventricular function or cardiogenic shock. Nevertheless, this new procedure has some potential risks, especially during the phases of rapid pacing (valvuloplasty and valve deployment). The use of cardiopulmonary bypass allows the perioperative risk to be reduced. Method: Between April 2008 and August 2011, 512 consecutive patients underwent transcatheter aortic valve implantation. Cardiopulmonary bypass was used in 35 patients. In this special group, there were 17 men and 18 women with a mean age of 77 +/- 12 years (range, 38-92 years). Left ventricular ejection fraction was a mean of 32% +/- 19% (range, 10%-70%), European System for Cardiac Operative Risk Evaluation was 60% +/- 27% (range, 13%-97%), and Society of Thoracic Surgeons' mortality score was 35% +/- 28% (range, 4%-90%). Results: Cardiopulmonary bypass was used in 13 patients with preoperative cardiogenic shock, 11 patients with impaired heart function during the procedure, 7 patients with severely impaired left ventricular function (left ventricular ejection fraction, 17% +/- 6%; range, 10%-30%), 3 patients with concomitant conventional surgical procedures, and 1 patient with impaired right ventricular function. The technical success rate was 94%, 30-day mortality was 20%, and 1-year survival was 46%. Conclusions: The use of cardiopulmonary bypass enhances safety in critical transcatheter aortic valve implantation procedures. Furthermore, transcatheter aortic valve implantation with cardiopulmonary bypass seems to provide better results than medical therapy or conventional aortic valve replacement in critically ill patients. The need for cardiopulmonary bypass emphasizes that the procedure should be performed only in cooperation between cardiologists and cardiac surgeons. (J Thorac Cardiovasc Surg 2013; 145: 757-63)