Tam Derrick Y, Jones Philip M, Kiaii Bob, Diamantouros Pantelis, Teefy Patrick, Bainbridge Daniel, Cleland Andrew, Fernandes Philip, Chu Michael W A
Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Can J Anaesth. 2015 Aug;62(8):918-26. doi: 10.1007/s12630-015-0393-0. Epub 2015 Apr 29.
Emergency rescue plans for acute complications during transcatheter aortic valve implantation (TAVI) commonly include cardiopulmonary resuscitation, femoro-femoral cardiopulmonary bypass (CPB), and hemodynamic stabilization before definitive intervention is achieved. Nevertheless, most cases of emergency resuscitation remain chaotic and disorganized and often take longer than necessary, even in experienced centres. We sought to determine which factors and procedures may be associated with improved patient outcomes when emergencies arise during TAVI.
MEDLINE(®) and EMBASE™ were searched with the following key words: "TAVI" or "TAVR" or "transcatheter valve implantation" or "transcatheter valve replacement" and "emergency cardiac surgery" or "conversion". Two hundred seventeen articles met the criteria and were reviewed.
Utilization of a formal emergency checklist by a multidisciplinary TAVI team may reduce procedural errors, smooth the transition to CPB, and ultimately speed the delivery of corrective measures including emergency cardiac surgery.
A well-organized regularly-rehearsed emergency rescue plan that preassigns resuscitative roles may shorten the duration of patient instability and resuscitation and improve patient outcomes when catastrophe occurs in TAVI. The anesthesia team plays a central role in preventing, detecting, and treating intraprocedural complications during TAVI.
经导管主动脉瓣植入术（TAVI）期间急性并发症的应急救援计划通常包括心肺复苏、股-股体外循环（CPB）以及在实现最终干预之前的血流动力学稳定。然而，即使在经验丰富的中心，大多数紧急复苏情况仍然混乱无序，且往往耗时比必要的时间更长。我们试图确定在TAVI期间出现紧急情况时，哪些因素和程序可能与改善患者预后相关。
使用以下关键词检索MEDLINE(®)和EMBASE™：“TAVI”或“TAVR”或“经导管瓣膜植入术”或“经导管瓣膜置换术”以及“急诊心脏手术”或“转换”。217篇文章符合标准并进行了综述。
多学科TAVI团队使用正式的应急清单可能会减少操作失误，使向CPB的过渡更加顺畅，并最终加快包括急诊心脏手术在内的纠正措施的实施。
一个组织良好、定期演练且预先分配复苏角色的应急救援计划，在TAVI发生灾难时可能会缩短患者不稳定和复苏的持续时间，并改善患者预后。麻醉团队在预防、检测和治疗TAVI术中并发症方面发挥着核心作用。
