Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Cerebral Oxygen Saturation Predicts Outcome after Transfemoral Transcatheter Aortic Valve Implantation

P. C. Seppelt1, S. Mas-Peiro1, Z. Dimitriadis1, A. Van Linden2, K. Zacharowski3, T. Walther2, S. Fichtlscherer1, M. Vasa-Nicotera1

1Med. Klinik III - Kardiologie Zentrum der Inneren Medizin, Universitätsklinikum Frankfurt, Frankfurt am Main; 2Klinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Frankfurt, Frankfurt am Main; 3Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Frankfurt am Main;

Background Cerebral oxygen saturation (ScO2) can be measured noninvasively by near-infrared spectroscopy (NIRS) and correlates with cerebral perfusion. We investigated cerebral saturation during transfemoral transcatheter aortic valve implantation (TAVI) and its impact on outcome. Methods and Results Cerebral oxygenation was measured continuously by NIRS in 173 analgo-sedated patients during transfemoral TAVI (female 47%, mean age 81 years) with self-expanding (39,3%) and balloon-expanding valves. Descriptive analysis of the cohort and intraprocedural dynamics of cerebral oxygenation was performed and the impact on outcome investigated. Mean ScO2 at baseline without oxygen supply was 60.4%. During rapid ventricular pacing ScO2 dropped significantly (63.9% vs. 55.2%, p<0.001). Baseline ScO2 correlated positively with left ventricular ejection fraction (0.230, p<0.006) and hemoglobin (0.327, p<0.001) and inversely with EuroSCORE-II (-0.285, p<0.001) and in-hospital stay (-0.229, p<0.01). Patients with ScO2 <56% despite oxygen supply at baseline had impaired 1-year survival (log rank test p=0.01) and prolonged in-hospital stay (p=0.03). Furthermore, baseline ScO2 was found to be a predictor for 1-year survival independent of age, sex and hemoglobin (multivariable adjusted cox regression, p= 0.020, hazard ration (HR 0.94, 95%CI 0.89-0.99) and independent of overall perioperative risk estimated by EuroSCORE-II and hemoglobin (p=0.160, HR 0.96, 95%CI 0.91-1.02). Conclusions Low baseline ScO2 not responding to oxygen supply reflects impaired cardiopulmonary function and is associated with worse one-year survival and prolonged in-hospital stay after transfemoral TAVI. ScO2 monitoring is an easy to implement diagnostic tool to screen for patients at risk with preserved recovery and worse outcome after TAVI.

https://dgk.org/kongress_programme/jt2022/aP1573.html