Emergency and Prophylactic ECMO for Patients Undergoing Valve-in-Valve Transcatheter Aortic Valve Implantation with Small Surgical Bioprosthesis

cureus.com August 15, 2024

Mechanical circulatory support (MCS) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is widely implemented as a rescue device in transcatheter aortic valve implantation (TAVI).

Although prophylactic VA-ECMO (pECMO) in TAVI is preferable to emergency VA-ECMO (eECMO) in terms of overall survival, there is currently no consensus on the introduction criteria for pECMO. Here, we report four cases of eECMO and pECMO performed in valve-in-valve TAVI (ViV-TAVI) with a small surgical bioprosthesis to consider the validity of the current pECMO indications.

In the two cases that were placed on eECMO, a 19 mm and 21 mm Carpentier-Edwards perimount bioprosthesis (CEP), a stented bioprosthetic valve, were sewn. After the transcatheter heart valve (THV) passed through the surgical aortic valve, acute aortic regurgitation developed, thus leading to hemodynamic instability requiring cardiopulmonary resuscitation, and therefore VA-ECMO was introduced.