Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Lazarettstrasse 36, 80636, Munich, Germany.
Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie, University of Regensburg Medical Center, Regensburg, Germany.
Clin Res Cardiol. 2019 Apr;108(4):366-374. doi: 10.1007/s00392-018-1364-6. Epub 2018 Aug 28.
This study investigated the impact of prophylactic veno-arterial extracorporeal membrane oxygenation (pECMO) in patients with depressed left ventricular ejection fraction (dLVEF) undergoing transcatheter aortic valve implantation (TAVI).
Out of 1490 patients undergoing TAVI at two centers (2010-2015), 222 patients had dLVEF (≤ 40%). Of these, 21 patients (10%) underwent TAVI with pECMO. Complications and outcome according to pECMO were analyzed in the entire and in a propensity-matched population.
In the entire population, patients with pECMO had a higher logEuroScore I (33% ± 19 vs. 25% ± 17; p = 0.037), worse LVEF (26% ± 7 vs. 32% ± 7; p = 0.001), more major bleedings (29% vs. 9%; p = 0.015), higher transfusion rate (30% vs. 10%; p = 0.019) and longer in-hospital stay (9.0 [7.0;14.0] vs. 7.0 [5.0;10.0] days; p = 0.024). After propensity matching only transfusion rate remained higher with pECMO (30% vs. 7%; p = 0.025). In the entire population, rate and risk of 30-day mortality was higher with pECMO (24% vs. 6%, HR 95%CI 4.29 [1.51-12.19]; p = 0.006). In the matched population, this effect was attenuated (24% vs. 12%, HR 95%CI 2.09 [0.61-7.23]; p = 0.243). Cumulative rate and risk of 1-year mortality did not differ in the entire (log-rank p = 0.069; 39% vs. 22%, HR 95%CI 1.99 [0.94-4.24]; p = 0.074) nor in the matched population (log-rank p = 0.520; 39% vs. 31%, HR 95%CI 1.34 [0.55-3.28]; p = 0.523).
In patients with dLVEF undergoing TAVI, periprocedural pECMO support does not seem to improve patient outcome.
本研究旨在探讨预防性静脉-动脉体外膜肺氧合（pECMO）对左心室射血分数（LVEF）降低的行经导管主动脉瓣植入术（TAVI）患者的影响。
在两个中心（2010-2015 年）接受 TAVI 的 1490 例患者中，有 222 例患者的 LVEF（≤40%）。其中，21 例（10%）患者接受了 TAVI 联合 pECMO。分析了在整个队列和倾向性匹配队列中 pECMO 相关并发症和结局。
在整个队列中，pECMO 组患者的 logEuroScore I 更高（33%±19 比 25%±17；p=0.037），LVEF 更差（26%±7 比 32%±7；p=0.001），大出血更多（29%比 9%；p=0.015），输血率更高（30%比 10%；p=0.019），住院时间更长（9.0[7.0;14.0] 比 7.0[5.0;10.0] 天；p=0.024）。倾向性匹配后，仅输血率在 pECMO 组更高（30%比 7%；p=0.025）。在整个队列中，pECMO 组 30 天死亡率和风险更高（24%比 6%，HR 95%CI 4.29[1.51-12.19]；p=0.006）。在匹配队列中，这种影响减弱（24%比 12%，HR 95%CI 2.09[0.61-7.23]；p=0.243）。整个队列（对数秩检验 p=0.069；39%比 22%，HR 95%CI 1.99[0.94-4.24]；p=0.074）和匹配队列（对数秩检验 p=0.520；39%比 31%，HR 95%CI 1.34[0.55-3.28]；p=0.523）的 1 年死亡率的累积率和风险均无差异。
在 LVEF 降低的行经导管主动脉瓣植入术患者中，围手术期 pECMO 支持似乎并不能改善患者结局。
