Fu Bo, Zhang Shaopeng, Dai Shilin, Guo Zhigang, Jiang Nan, Han Jiange, Yang Li, Shang Yanwen, Ma Yanhe, Puehler Thomas, Bagur Rodrigo
Tianjin Medical University, Tianjin, China.
Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China.
Ann Transl Med. 2021 Aug;9(16):1336. doi: 10.21037/atm-21-3446.
Intraoperative hemodynamic collapse during transcatheter aortic valve implantation (TAVI) is a devastating complication that requires mechanical support. In this study, we sought to analyze our early experience in using cardiopulmonary bypass (CPB) support to circumvent circulatory compromise during TAVI.
Between January 2018 and December 2020, 102 consecutive patients (54 males; mean age, 71.2±8.9 years) received TAVI at Tianjin Chest Hospital, and an emergency CPB device was used in 6 of these patients (5.9%). The clinical data of the CPB and no-CPB groups were analyzed to identify the factors associated with intraoperative hemodynamic collapse requiring CPB.
All 6 patients who needed emergency CPB support were successfully weaned from the device. This group had a higher Society of Thoracic Surgeons Score [4.09 (2.02, 6.85) 7.47 (5.07, 23.46); P=0.030], more patients with a left ventricular ejection fraction (LVEF) ≤30% [4 (66.7%) 2 (2.1%); P=0.000], a larger right ventricle anteroposterior diameter [20.50 (19.75, 21.25) 19.00 (17.00, 20.00); P=0.016], and a higher degree of aortic regurgitation [4.50 (2.75, 5.00) 2.00 (1.00, 4.00); P=0.018] compared to the no-CPB group. The CPB group also had a higher in-hospital mortality rate than did the no-CPB group (16.7% 4.7%; P=0.026). Multivariable analysis determined that the presence of lower pre-TAVI LVEF was associated with intraoperative hemodynamic collapse.
Our results indicate that LVEF is an independent risk factor for requiring emergency CPB during the TAVI procedure. The need for emergency CPB support was associated with higher in-hospital mortality.
经导管主动脉瓣植入术（TAVI）期间的术中血流动力学崩溃是一种毁灭性并发症，需要机械支持。在本研究中，我们试图分析我们在使用体外循环（CPB）支持以规避TAVI期间循环功能不全方面的早期经验。
2018年1月至2020年12月期间，102例连续患者（54例男性；平均年龄71.2±8.9岁）在天津胸科医院接受了TAVI，其中6例患者（5.9%）使用了紧急CPB设备。分析CPB组和非CPB组的临床数据，以确定与需要CPB的术中血流动力学崩溃相关的因素。
所有6例需要紧急CPB支持的患者均成功脱离该设备。与非CPB组相比，该组患者的胸外科医师协会评分更高[4.09（2.02，6.85）对7.47（5.07，23.46）；P = 0.030]，左心室射血分数（LVEF）≤30%的患者更多[4例（66.7%）对2例（2.1%）；P = 0.000]，右心室前后径更大[20.50（19.75，21.25）对19.00（17.00，20.00）；P = 0.016]，主动脉瓣反流程度更高[4.50（2.75，5.00）对2.00（1.00，4.00）；P = 0.
