Low Ejection Fraction Is a Predictor of Intraprocedural Cardiopulmonary Resuscitation in Patients Undergoing TAVI

Objectives: Transcatheter aortic valve implantation (TAVI) is still performed predominantly in high-risk patients suffering from aortic stenosis. The experience in this field is growing exponentially and the incidence of complications has decreased over the last decade. One of the most serious complications is intra-procedural cardiopulmonary resuscitation (CPR) due to its negative impact on outcome. We retrospectively analyzed potential predictors leading to intra-procedural CPR.

Methods: Between April 2013 and March 2016 a total number of 43 patients undergoing TAVI in our institution required intra-procedural CPR. To determine potential predictors all patients with intra-procedural CPR were compared with non-CPR cohort of 217 patients. The outcome was defined according to the current VARC-2 criteria.

Results: Transfemoral approach was the preferred access in more than 80% of patients in both groups (84.7% CPR vs. 83.7% non-CPR). Both groups did not differ in regards to most baseline characteristics and were comparable, except for higher weight, higher incidence of preoperative atrial fibrillation and higher rate of hyperlipidemia in the non-CPR group (p < 0.05). Patients of the CPR group presented with a significantly lower ejection fraction (43 [23; 82]% vs. 60 [10; 83]%, p < 0.05) and showed lower preoperative transvalvular mean pressure gradients (42 [10; 130] mm Hg vs. 38 [11; 80] mm Hg, p < 0.05). Patients with intraprocedural CPR were also associated with significantly longer procedure durations (80 [45; 245] vs. 99 [45; 250], p < 0.001), higher need for red blood transfusions (p < 0.05), higher incidence of postoperative stroke (p < 0.05) and worse in-hospital survival (p < 0.05).

Conclusion: Patients undergoing TAVI with intra-procedural CPR are at high risk of poor outcome. Our study shows that lower ejection fraction may be strongly associated with intra-procedural CPR and consecutively with worse outcome. However, more data are needed to find further predictors for intra-procedural CPR in patients undergoing TAVI.