中国体外循环杂志2019，Vol.17Issue(1)：13-17,5.DOI:10.13498/j.cnki.chin.j.ecc.2019.01.04
体外膜肺氧合辅助经导管主动脉瓣植入治疗极低射血分数值的重度主动脉瓣狭窄
TAVI with extracorporeal membrane oxygenation support in patients with severe aortic stenosis and extremely low left ventricular ejection fraction
摘要
Abstract
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％ and22％, 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 (PGmax) decreased to 3-7 mm Hg, 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 increased 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.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Key words
Extracorporeal membrane oxygenation/Transcatheter aortic valve implantation/Aortic stenosis/Heart failure/Left ventricular ejection fraction/Advanced age引用本文复制引用
刘洋,丁鹏,程亮,金屏,唐嘉佑,姬鹏飞,金振晓,俞世强,杨剑..体外膜肺氧合辅助经导管主动脉瓣植入治疗极低射血分数值的重度主动脉瓣狭窄[J].中国体外循环杂志,2019,17(1):13-17,5.基金项目
国家自然科学基金青年项目 (81500319, 81570231) （81500319, 81570231）
陕西省社发攻关课题 (2016SF-225, 2015SF-109) （2016SF-225, 2015SF-109）
军队后勤科研重大项目 (ALJ17J001) （ALJ17J001）
