Since its approval by the Food and Drug Administration in 2011, transcatheter aortic valve implantation (TAVI) has rapidly evolved to become the preferred ultimate intervention for high- and intermediate-risk patients with severe symptomatic aortic stenosis.[1] This is due to its non-open-heart, minimally invasive and off-pump advantages.[1] Nevertheless, as a result of the frequent frailty and comorbidity profiles of patients undergoing TAVI, such as advanced cardiac dysfunction and extensive coronary artery disease, or technically difficult anatomy for the procedure itself,[2–4] it is common for these patients to experience critical circulatory collapse perioperatively. These factors are linked to elevated mortality rates, necessitating suitable mechanical circulatory support (MCS) to reverse the disastrous situations.[5]

Both extracorporeal membrane oxygenation (ECMO) and cardiopulmonary bypass (CPB) are potent MCS devices for circulatory collapse during TAVI, as they are independent of cardiopulmonary function and therefore allow for more sufficient support than other MCSs in cases of circulatory failure.[6–9] While there are some similarities between CPB and ECMO, there are also a number of distinctions.[10] No guidelines have recommended which techniques, either ECMO or CPB primarily used, would contribute to greater clinical benefit when circulatory collapse occurs. Herein, we conducted a pooled analysis to compare the survival outcomes of patients who underwent TAVI with either ECMO or CPB as their primary MCS.