TY  - JOUR
A1  - Seppelt, Philipp
A1  - Mas-Peiro, Silvia
A1  - Linden, Arnaud van
A1  - Iken, Sonja
A1  - Zacharowski, Kai
A1  - Walther, Thomas
A1  - Fichtlscherer, Stephan
A1  - Vasa-Nicotera, Mariuca
T1  - Cerebral oxygen saturation as outcome predictor after transfemoral transcatheter aortic valve implantation
T2  - Clinical research in cardiology
N2  - Background: Cerebral oxygen saturation (ScO2) can be measured non-invasively 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%) and balloon-expanding valves (61%). We investigated the periprocedural dynamics of cerebral oxygenation. Mean ScO2 at baseline without oxygen supply was 60%. During rapid ventricular pacing, ScO2 dropped significantly (before 64% vs. after 55%, p < 0.001). ScO2 at baseline correlated positively with baseline 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 length of 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 and sex (multivariable adjusted Cox regression, p = 0.020, hazard ratio (HR 0.94, 95% CI 0.90–0.99) and independent of overall perioperative risk estimated by EuroSCORE-II and hemoglobin (p = 0.03, HR 0.95, 95% CI 0.91–0.99).
Conclusions: Low baseline ScO2 not responding to oxygen supply might act as a surrogate for impaired cardiopulmonary function and is associated with worse 1 year survival and prolonged in-hospital stay after transfemoral TAVI. ScO2 monitoring is an easy to implement diagnostic tool to screen patients at risk with a potential preserved recovery and worse outcome after TAVI.
KW  - Valvular cardiomyopathy
KW  - Aortic stenosis
KW  - Cerebral oxygen saturation
KW  - TAVI
Y1  - 2022
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/69628
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-696283
SN  - 1861-0692
N1  - Open Access funding enabled and organized by Projekt DEAL.
VL  - 111
IS  - 8
SP  - 955
EP  - 965
PB  - Springer
CY  - Berlin
ER  -