Abstract 13750: In-Hospital Outcomes of Mechanical Circulatory Support in Transcatheter Aortic Valve Implantation

Introduction: Transcatheter aortic valve implantation (TAVI) is rarely complicated by acute circulatory collapse. Mechanical circulatory support (MCS) acts as a bridge to definitive intervention in these patients, however, the outcomes of MCS devices in TAVI patients are not well studied. Methods: Using the Nationwide Inpatient Sample Database from 2016 to 2018, we identified patients who underwent TAVI and required MCS using ICD-10 codes. The MCS devices included intra-aortic balloon pump (IABP) (group 1), Impella (group 2), and extracorporeal membrane oxygenation (ECMO) (group 3). Patients <18 years and those requiring more than one device use were excluded. The primary outcome was in-hospital mortality and secondary outcomes were cardiac arrest, cerebrovascular accident, myocardial infarction, and renal failure. Results: Our analysis included 148,210 TAVI patients (based on weighted sample) with 1250 requiring MCS devices (IABP N=655, Impella N=360, ECMO N=235). Patients who required Impella were older than those who required ECMO and IABP (mean age group 1 75.8 ± 11.3, group 78.3 ± 10.1, group 3). The utilization of MCS devices was not different among the gender (females 46.2%; p = 0.2376) and races (Whites 86.8%, African Americans 4.26%, Hispanics 4.96%; p = 0.5038). Incidence of in-hospital mortality was highest in ECMO (group 1 27.5%, group 2 38.9%, group 3 42.6%, p < 0.001) (Figure). The multivariate logistic regression model adjusted for MCS devices, age, race, sex, hypertension, diabetes, cardiopulmonary disease, kidney disease (CKD), liver disease, peripheral arterial disease (PAD), and arrhythmias indicated that use of any MCS device, age, female sex, congestive heart failure, CKD, liver disease, PAD, and arrhythmias were independent predictors of in-hospital mortality. Conclusions: In TAVI, the use of ECMO was associated with higher in-hospital mortality, cardiac arrest, major bleeding, and renal failure when compared to Impella and IABP.