Higuchi Ryosuke, Tobaru Tetsuya, Hagiya Kenichi, Saji Mike, Takamisawa Itaru, Shimizu Jun, Iguchi Nobuo, Takanashi Shuichiro, Takayama Morimasa, Isobe Mitsuaki
Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo, 183-0003, Japan.
Department of Anesthesiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo, 183-0003, Japan.
Heart Vessels. 2018 Nov;33(11):1343-1349. doi: 10.1007/s00380-018-1183-8. Epub 2018 May 2.
Transcatheter aortic valve implantation (TAVI) has been established as a low-invasive therapy for aortic stenosis, but circulatory collapse necessitating mechanical circulatory support could occur during TAVI due to procedure itself or procedural complications. The purpose of this study is to describe the outcomes of patients requiring extracorporeal membrane oxygenation (ECMO) in TAVI. Among 384 consecutive patients undergoing TAVI from April 2010 to July 2017 in Sakakibara Heart Institute, we evaluated seven patients (1.8%) who required ECMO during procedure. The definitions of outcome were derived from Valve Academic Research Consortium-2 criteria. The indication of ECMO included bridge to emergent surgery due to mechanical complication (n = 3) [aortic root rupture (n = 2), and left-ventricle rupture (n = 1); emergent use], bridge to recovery from cardiac stunning (n = 3; emergent use), and circulatory support for cardiogenic shock (n = 1; prophylactic use). All patients were cannulated from femoral artery and vein, and there was no ECMO-related complication. Six out of seven patients were weaned from ECMO during the TAVI procedure, whereas the other patient with annulus rupture died the following day after TAVI. Five patients survived to discharge [postoperative hospital stay: 27.6 ± 24.3 (23) days]. During mean follow-up of 253 days, a total of three patients died due to annulus rupture, refractory heart failure, and pneumonia, respectively. ECMO is effective and a safe mechanical support device during TAVI. The mid-term outcomes of patients who needed ECMO were unfavorable. Further evolution of transcatheter heart valve is essential, and prophylactic ECMO may contribute to better prognosis in selected patients.
经导管主动脉瓣植入术（TAVI）已成为治疗主动脉瓣狭窄的一种低侵入性疗法，但在TAVI过程中，由于手术本身或手术并发症，可能会发生需要机械循环支持的循环衰竭。本研究的目的是描述TAVI中需要体外膜肺氧合（ECMO）的患者的结局。在2010年4月至2017年7月在酒匂心脏研究所连续接受TAVI的384例患者中，我们评估了7例（1.8%）在手术过程中需要ECMO的患者。结局的定义源自瓣膜学术研究联盟-2标准。ECMO的适应证包括因机械并发症（n = 3）[主动脉根部破裂（n = 2）和左心室破裂（n = 1）；紧急使用]而过渡到紧急手术、从心脏顿抑中恢复的过渡（n = 3；紧急使用）以及对心源性休克的循环支持（n = 1；预防性使用）。所有患者均通过股动脉和股静脉插管，且未发生与ECMO相关的并发症。7例患者中有6例在TAVI手术期间脱离了ECMO，而另1例瓣环破裂的患者在TAVI术后次日死亡。5例患者存活出院[术后住院时间：27.6±24.3（23）天]。在平均253天的随访期间，共有3例患者分别因瓣环破裂、难治性心力衰竭和肺炎死亡。ECMO在TAVI期间是一种有效且安全的机械支持装置。需要ECMO的患者的中期结局不佳。经导管心脏瓣膜的进一步发展至关重要，预防性ECMO可能有助于改善部分患者的预后。
