摘要
目的探讨体外膜肺氧合(ECMO)辅助经导管主动脉瓣植入(TAVI)治疗极低左室射血分数(LVEF)值重度主动脉瓣狭窄患者的临床应用疗效。方法 2018年1月至2018年10月,71例高龄主动脉瓣狭窄患者接受TAVI术,其中4例极低LVEF值患者在ECMO辅助下完成TAVI手术。男性3例,女性1例,年龄60～74(68.5±3.2)岁,体质量47～76(65.4±6.4)kg。患者术前均为主动脉瓣重度狭窄,术前NYHA分级均为IV级。所有患者术前均行经胸超声及CT血管成像(CTA)检查,LVEF值分别为14%,20%,17%,22%。术中全麻及静脉-动脉ECMO(V-A ECMO)置管辅助下,3例行经股动脉TAVI,1例行经心尖TAVI。术后3例在手术室脱离ECMO辅助,1例ECMO辅助下转入ICU。结果 4例患者均手术成功,ECMO转流时间分别为116 min,60 min,38 min,84 h。瓣膜植入并撤离ECMO辅助后,3例LVEF值回升,1例无明显变化。瓣膜植入后最大压差(PGmax)降至3～7 mm Hg。瓣周返流为0～4 ml,4例患者均无Ⅲ度房室传导阻滞。术后患者胸闷气短等心功能不全表现均明显改善,无死亡及重要并发症。随访3～6个月,患者症状较前明显改善,B超提示LVEF均有所恢复,分别为40%,42%,48%及38%。与同期常规TAVI手术患者相比,术前LVEF值明显较低,但住院时间、随访3个月LVEF值无明显差异。结论 ECMO辅助TAVI手术治疗极低LVEF值重度主动脉瓣狭窄患者,能够提高手术安全性,且预后近期疗效满意。
Objective To investigate the clinical efficacy of TAVI with extracorporeal membrane oxygenation(ECMO)support in the treatment of severe aortic stenosis with extremely low left ventricular ejection fraction(LVEF).Methods From January 2018 to October 2018,71 cases of patients with aortic stenosis underwent transcatheter aortic valve implantation(TAVI)in our hospital.Of those patients,four with very low EF underwent TAVI with ECMO support.There were 3 males and 1 female,aged 60-74(68.5±3.2)years old,weighting 47-76(65.4±6.4)kg.All patients had severe aortic stenosis.Their heart function grades were all NYHA IV class.All patients underwent transthoracic echocardiography and CTA before procedures,and the EF values were 14%,20%,17%and 22%,respectively.With general anesthesia and V-A ECMO through femoral approach,three patients underwent transfemoral TAVI,and one patient underwent transapical TAVI.ECMO was removed in three cases in the operating room,while one patient was transferred to the ICU with ECMO.Results All patients discharged from the hospital successfully.The duration of ECMO support was 116 min,60 min,38 min,and 84 h,respectively.After valve implantation and withdrawal from ECMO,the maximum pressure gradient(PG.max)decreased to 3-7 mmHg,with the paravalvular regurgitation of 0 to 4 ml.No atrioventricular block was detected.No mortality or severe complications occurred.During 3-6 months'follow-up,the patients'physical conditions improved significantly.The LVEF in.creased to 40%,42%,48%and 38%,respectively at 3-month follow-up.Compared with patients underwent TAVI without ECMO support,their preoperative EF was significantly lower,but there was no significant difference in EF at 3-month follow-up.Conclusion TAVI with ECMO support could improve safety of the procedure and the short-term outcome was reliable in patients with severe aortic stenosis and extremely low EF.
作者
刘洋
丁鹏
程亮
金屏
唐嘉佑
姬鹏飞
金振晓
俞世强
杨剑
Liu yang;Ding Peng;Cheng Liang;Jin Ping;Tang Jiayou;Ji Pengfei;Jin Zhenxiao;Yu Shiqiang;Yang Jian(Department of Cardiac Surgery, Xijing Hospital, Air Force Medical University, Shaanxi Xi'an 710032, China)
出处
《中国体外循环杂志》
2019年第1期13-17,共5页
Chinese Journal of Extracorporeal Circulation
基金
国家自然科学基金青年项目(81500319
81570231)
陕西省社发攻关课题(2016SF-225
2015SF-109)
军队后勤科研重大项目(ALJ17J001)
关键词
体外膜肺氧合
经导管主动脉瓣植入
主动脉瓣狭窄
心功能不全
左室射血分数
高龄
Extracorporeal membrane oxygenation
Transcatheter aortic valve implantation
Aortic stenosis
Heart failure
Left ventricular ejection fraction
Advanced age
作者简介
通讯作者:杨剑,Email:yangjian@fmmu.edu.cn.
