Klinik und Poliklinik für Innere Medizin II, University of Regensburg Medical Center, Regensburg, Germany.
Catheter Cardiovasc Interv. 2013 Oct 1;82(4):E542-51. doi: 10.1002/ccd.24806. Epub 2013 Apr 29.
To report our center's experience using veno-arterial extracorporeal membrane oxygenation (vaECMO) in transcatheter aortic valve implantation (TAVI).
In TAVI, short-term mortality closely relates to life threatening procedural complications. VaECMO can be used to stabilize the patient in emergency situations. However, for the prophylactic use of vaECMO in very high-risk patients undergoing TAVI there is no experience.
From January 2009 to August 2011, we performed 131 TAVI. Emergency vaECMO was required in 8 cases (7%): ventricular perforation (n = 3), hemodynamic instability/cardiogenic shock (n = 4), hemodynamic deterioration due to ventricular tachycardia (n = 1). Since August 2011, during 83 procedures, prophylactic vaECMO was systematically used in very high-risk patients (n = 9, 11%) and emergency ECMO in one case (1%) due to ventricular perforation.
Median logistic EuroScore in prophylactic vaECMO patients was considerably higher as compared to the remaining TAVI population (30% vs. 15%, P = 0.0003) while in patients with emergency vaECMO it was comparable (18% vs. 15%, P = 0.08). Comparing prophylactic to emergency vaECMO, procedural success and 30-day mortality were 100% vs. 44% (P = 0.03) and 0% vs. 44% (P = 0.02), respectively. Major vascular complications and rate of life threatening bleeding did not differ between both groups (11% vs. 11%, P = 0.99 and 11% vs. 33%, P = 0.3) and were not vaECMO-related.
Life-threatening complications during TAVI can be managed using emergency vaECMO but mortality remains high. The use of prophylactic vaECMO in very high-risk patients is safe and may be advocated in selected cases.
报告我们中心在经导管主动脉瓣植入术（TAVI）中使用静脉-动脉体外膜肺氧合（vaECMO）的经验。
在 TAVI 中，短期死亡率与危及生命的程序并发症密切相关。vaECMO 可用于在紧急情况下稳定患者。然而，对于在接受 TAVI 的极高风险患者中预防性使用 vaECMO，尚无经验。
从 2009 年 1 月至 2011 年 8 月，我们进行了 131 例 TAVI。8 例（7%）需要紧急 vaECMO：心室穿孔（n = 3）、血流动力学不稳定/心源性休克（n = 4）、由于室性心动过速导致血流动力学恶化（n = 1）。自 2011 年 8 月以来，在 83 例手术中，在极高风险患者（n = 9，11%）中系统使用预防性 vaECMO，在一例（1%）由于心室穿孔而紧急使用 ECMO。
预防性 vaECMO 患者的中位逻辑欧洲评分明显高于其余 TAVI 人群（30%比 15%，P = 0.0003），而在紧急 vaECMO 患者中则相当（18%比 15%，P = 0.08）。比较预防性和紧急 vaECMO，程序成功率和 30 天死亡率分别为 100%和 44%（P = 0.03）和 0%和 44%（P = 0.02）。两组之间主要血管并发症和危及生命出血的发生率没有差异（11%比 11%，P = 0.99 和 11%比 33%，P = 0.3），并且与 vaECMO 无关。
TAVI 期间危及生命的并发症可以通过紧急 vaECMO 来治疗，但死亡率仍然很高。在极高风险患者中使用预防性 vaECMO 是安全的，并可在选定病例中提倡。
