Department of Anesthesiology, The University of Texas at Houston, McGovern Medical School/Memorial Hermann Heart and Vascular Institute, Houston, Texas, USA.
Department of Cardiology, The University of Texas at Houston, McGovern Medical School/Memorial Hermann Heart and Vascular Institute, Houston, Texas, USA.
Can J Cardiol. 2021 Oct;37(10):1522-1529. doi: 10.1016/j.cjca.2021.05.002. Epub 2021 May 14.
Perioperative complications of transcatheter aortic valve replacement (TAVR) are decreasing but can be catastrophic when they occur. Systematic reports of the nature of these events are lacking in the contemporary era. Our study aimed to report the incidence, outcomes, and perioperative management of catastrophic cardiac events in patients undergoing TAVR and to propose a working strategy to address these complications.
This is a retrospective cohort study of patients who developed catastrophic cardiac events during or immediately after TAVR between 2015 and 2019 at a single academic centre.
Of 2102 patients who underwent TAVR, 51 (2.5%) developed catastrophic cardiac events. The causes included cardiac perforation and tamponade (n = 19, 37.3%), acute left- ventricular failure (n = 10, 19.6%), coronary artery obstruction (n = 10, 19.6%), aortic-root disruption (n = 7, 13.7%), and device embolization (n = 5, 9.8%). Twenty-four patients (47.0%) with catastrophic cardiac events required stabilization by either intra-aortic balloon counter-pulsation or extracorporeal membrane oxygenation. The in-hospital mortality rate increased by 11.7-fold for patients with catastrophic cardiac events compared with those without (25.5% vs 2.0%, P < 0.001). Patients who developed aortic root disruption had the highest mortality rate (42.8%) compared with the others. The incidence of catastrophic cardiac events remained stable over a 5-year period, but the associated mortality decreased from 38.5% in 2015 to 9.1% in 2019.
Catastrophic cardiac events during TAVR are rare, but they account for a dramatic increase in perioperative mortality. Early recognition and development of a standardized perioperative team approach can help manage patients experiencing these complications.
经导管主动脉瓣置换术（TAVR）的围手术期并发症虽在减少，但发生时可能是灾难性的。在当代，缺乏对这些事件性质的系统报告。我们的研究旨在报告在单一学术中心接受 TAVR 的患者发生灾难性心脏事件的发生率、结局和围手术期管理，并提出解决这些并发症的工作策略。
这是一项回顾性队列研究，纳入了 2015 年至 2019 年期间在单一学术中心接受 TAVR 期间或之后立即发生灾难性心脏事件的患者。
在 2102 例接受 TAVR 的患者中，有 51 例（2.5%）发生了灾难性心脏事件。病因包括心脏穿孔和心脏压塞（n=19，37.3%）、急性左心室衰竭（n=10，19.6%）、冠状动脉阻塞（n=10，19.6%）、主动脉根部破裂（n=7，13.7%）和器械栓塞（n=5，9.8%）。24 例（47.0%）发生灾难性心脏事件的患者需要通过主动脉内球囊反搏或体外膜氧合进行稳定。与未发生灾难性心脏事件的患者相比，发生灾难性心脏事件的患者住院死亡率增加了 11.7 倍（25.5% vs 2.0%，P<0.001）。与其他类型相比，发生主动脉根部破裂的患者死亡率最高（42.8%）。灾难性心脏事件的发生率在 5 年内保持稳定，但相关死亡率从 2015 年的 38.5%降至 2019 年的 9.1%。
TAVR 期间发生的灾难性心脏事件罕见，但会导致围手术期死亡率显著增加。早期识别和制定标准化围手术期团队方法有助于管理发生这些并发症的患者。
