摘要
目的探讨3D打印联合体外膜肺氧合(ECMO)辅助在经导管主动脉瓣置换术(TAVR)治疗低射血分数重度主动脉瓣狭窄中的可行性和有效性。方法低射血分数重度主动脉瓣狭窄患者10例,于2018年11月—2019年5月在空军军医大学西京医院接受ECMO辅助下经导管主动脉瓣置换术,术前左心室射血分数(LVEF)为(30.3%±10.5%),心功能Ⅳ级(NYHA分级)10例。术前采集患者CT数据,重建患者手术入路,结合3D打印技术制作患者心血管模型辅助术前评估、手术方案确定及术前谈话。结果 10例患者均成功接受TAVR手术,围手术期患者血流动力学指标稳定,手术时间(192.5±30.3) min,DSA照射时间(40.5±3.2) min,ECMO辅助时间(60.5±23.9) min,患者出院后术后1月随访心脏超声提示心功能改善,LVEF为(48.5%±4.3%)。结论对于低射血分数重度主动脉瓣狭窄的患者在行TAVR时,治疗难度大,3D打印技术为医护人员提供直观模型,辅助医患沟通及术前评估,ECMO辅助可保证患者围手术期的血流动力学稳定,提供有效心肺功能支持,有助于提高手术成功率。
Aim To investigate the feasibility and effectiveness of 3D printing and extracorporeal membrane oxygenation assistant in transcatheter aortic valve replacement(TAVR)of severe aortic stenosis patients.Methods From November 2018 to May 2019,10 patients with severe aortic stenosis underwent transcatheter aortic valve replacement assisted by ECMO in Xijing Hospital of Air Force Military Medical University.The preoperative left ventricular ejection fraction(LVEF)was(30.3%±10.5%).The preoperative cardiac function grade of all patients wasⅣgrade(NYHA).Before operation,CT data of all patients were collected and reconstructed.Their cardiovascular models were made by using 3D printing technology.All preoperative evaluation,operation scheme determination and preoperative conversation were done with 3D printing models.Results All the 10 patients received TAVR successfully.The hemodynamic indexes were stable in the perioperative period.The operation time was(192.5±30.3)min,and the DSA irradiation time was(40.5±3.2)min.The ECMO assistant time was(60.5±23.9)min.The echocardiography showed the heart function was improved.The LVEF was(48.5%±4.3%).Conclusion It is very difficult for patients with very high-risk aortic stenosis to be treated with TAVR.3D printing technology can provide doctors and nurses an intuitive model,assist doctors-patient communication and preoperative evaluation.ECMO can ensure the perioperative hemodynamic stability of patients and provide effective cardiopulmonary function support,thus to improve the success rate of TAVR.
作者
金屏
刘洋
郭红
杨景娟
宁丽娟
张艳
金艳
杨剑
JIN Ping;LIU Yang;GUO Hong;YANG Jingjuan;NING Lijuan;ZHANG Yan;JIN Yan;YANG Jian(Department of Cardiovascular Surgery,Xijing Hospital,Air Force Medical University,Xi’an,Shaanxi 710032,China)
出处
《中国动脉硬化杂志》
CAS
2020年第10期841-846,共6页
Chinese Journal of Arteriosclerosis
基金
国家重点研发计划(2016YFC1101000)
陕西省自然科学基础研究计划项目杰出青年科学基金(S2018-JC-JQ-0094)
陕西省创新能力支撑计划-科技创新团队项目(S2020-ZC-TD-0029)
西京医院学科助推计划(XJZT18MJ69)。
关键词
3D打印
主动脉瓣狭窄
经导管主动脉瓣置换
体外膜肺氧合
3D printing
aortic stenosis
transcatheter aortic valve replacement
extracorporeal membrane oxygenation
作者简介
金屏,硕士,主治医师,研究方向为结构性心脏病的介入治疗及心脏疾病常规外科手术治疗,E-mail为bohua001@126.com;通信作者:杨剑,博士,副教授,博士研究生导师,研究方向为心脏病的介入治疗及心脏疾病常规外科手术治疗,E-mail为yangjian@fmmu.edu.cn。
