Singh Vikas, Yarkoni Alon, O'Neill William W
Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida.
Center for Structural Heart Diseases, Henry Ford Health System, Detroit, Michigan.
Catheter Cardiovasc Interv. 2015 Jul;86(1):160-3. doi: 10.1002/ccd.25784. Epub 2015 Apr 2.
Sudden onset of hypotension is a rare but emergent event in patients undergoing transcatheter aortic valve replacement (TAVR). This primarily occurs due to coronary artery obstruction, valve misplacement/migration, ventricular perforation, cardiac tamponade, severe paravalvular regurgitation, stunned myocardium, ventricular arrhythmia, and annulus rupture. While the operator makes an attempt to identify and correct the underlying problem, an emergent placement of mechanical hemodynamic assist device may be necessary and crucial for a successful outcome. We describe a unique and challenging case of complete circulatory collapse in a patient undergoing transaortic TAVR with Edwards SAPIEN prosthesis (Edwards Lifesciences, CA) who required rescue Impella CP™ (Abiomed, Danvers, MA) placement directly through the ascending aorta due to unfavorable femoral access.
在接受经导管主动脉瓣置换术（TAVR）的患者中，突然发生低血压是一种罕见但紧急的情况。这主要是由于冠状动脉阻塞、瓣膜错位/移位、心室穿孔、心脏压塞、严重瓣周反流、心肌顿抑、室性心律失常和瓣环破裂所致。在操作者试图识别并纠正潜在问题的同时，紧急放置机械血流动力学辅助装置可能是必要的，且对成功结局至关重要。我们描述了一例独特且具有挑战性的病例，一名接受经主动脉TAVR并使用爱德华SAPIEN人工瓣膜（爱德华生命科学公司，加利福尼亚州）的患者发生了完全循环衰竭，由于股动脉入路不佳，需要直接通过升主动脉放置抢救用Impella CP™（阿比奥Med公司，马萨诸塞州丹弗斯）。
