摘要
目的探讨体外循环在经导管主动脉瓣置换术中的应用策略。方法回顾性分析我院2018年1月至2021年1月96例行经导管主动脉瓣置换术(transcatheter aortic valve implantation,TAVI)的高龄老年退行性主动脉瓣病变患者的临床资料,其中有6例在体外循环(cardiopulmonary bypass,CPB)辅助下完成手术,男性2例,女性4例,年龄70~84岁,平均(75.6±5.2)岁;均为极重度主动脉瓣狭窄,开口面积0.29~0.58cm^(2),平均(0.39±0.10)cm^(2);跨瓣压差69~106mmHg,平均(85.6±12.7)mmHg;合并主动脉瓣二瓣化畸形2例,心功能NYHA分级Ⅱ~Ⅳ级;中转开胸外科主动脉瓣置换(Surgical aortic valve replacement,SAVR)2例。结果TAVI手术中应用体外循环6例,应用比例为6.25%,2例为预防性应用,4例为挽救性应用,其中死亡2例(33.33%)。96例患者围术期共死亡4例,总体死亡率为4.16%,其中转正中开胸外科主动脉瓣置换2例,ECMO辅助1例。结论TAVI紧急中转体外循环死亡率较高。体外循环作为机械循环支持的重要组成部分,在维持血流动力学稳定方面起重要作用,对于极高危患者体外循环辅助下TAVI是安全可行的,一旦术中出现突发情况,建议尽早启动CPB。
Objective To explore the application strategy of cardiopulmonary bypass in transcatheter aortic valve replacement.Methods Retrospectively analyze the clinical data of 96 elderly patients with degenerative aortic valve disease undergoing transcatheter aortic valve implantation(TAVI)in our hospital from January 2018 to January 2021.In 6 cases,the operation was completed under the assistance of cardiopulmonary bypass(CPB).There were 2 males and 4 females,aged 70~84(75.6±5.2)years.All patients had extremely severe aortic stenosis,with an opening area of 0.29~0.58(0.39±0.10)cm and a cross-valve differential pressure of 69~106(85.6±12.7)mmHg.There were 2 patients with aortic divalvular malformation,and NYHA grading of heart function wasⅡ~Ⅳ.Among them,2 cases were transferred to surgical aortic valve replacement(SAVR).Results CPB was used in 6 cases(6.25%),2 cases were prophylactic,4 cases were salvage,and 2 cases died(33.33%).In the perioperative period,4 patients died,with an overall mortality rate of 4.16%,including 2 patients undergoing thoracic aortic valve replacement and 1 patient assisted by extracorporeal membrane oxygenationvECMO.Conclusion The mortality rate in TAVI with CPB emergency start is higher.As an important part of mechanical circulation supportvCPB plays an important role in maintaining hemodynamic stability,and TAVI is safe and feasible for extremely high-risk patients assisted by CPB.It is recommended to start CPB as soon as possible in case of emergency.
作者
任培军
王圣
程兆云
杨雷一
李建朝
REN Peijun;WANG Sheng;CHENG Zhaoyun;YANG Leiyi;LI Jianchao(Fuwai Central China Cardiovascular Hospital, Heart Center of Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan 450046, China)
出处
《中国老年保健医学》
2021年第6期134-137,共4页
Chinese Journal of Geriatric Care
基金
河南省疑难病症诊治能力提升工程建设项目(豫卫规划〔2018〕33号)
河南省医学科技攻关计划项目(No.201602208)。
关键词
体外循环
经导管主动脉瓣置换
cardiopulmonary bypass
transcatheter aortic valve implantation
作者简介
通讯作者:程兆云。
