Department of Cardiology, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Taiwan.
Institut für Anästhesiologie, Deutsches Herzzentrum München, Technical University Munich, 80333 Munich, Germany.
Medicina (Kaunas). 2022 Feb 28;58(3):356. doi: 10.3390/medicina58030356.
Transcatheter aortic valve implantation (TAVI) has evolved to be the treatment of choice for patients with severe aortic stenosis and high perioperative risk. Cardiogenic shock is one of the most severe complications during the TAVI procedure, especially as the prognosis of cardiogenic shock secondary to aortic stenosis is very poor. This situation can be challenging, while extracorporeal membranous oxygenation (ECMO) can be a treatment option. Here, we reported on an 88-year-old female patient who had been diagnosed as non-ST-elevation myocardial infarction (NSTEMI) and critical aortic valve stenosis (AS) with a logistic Euroscore of 25%. Percutaneous coronary angioplasty (PCI) was performed smoothly and developed tachy-brady arrhythmia of atrial fibrillation then cardiac arrest at the beginning of the TAVI procedure. A v-a ECMO was installed at her left femoral side. Afterward, the TAVI procedure was completed accordingly; her consciousness recovered and Levosimendan therapy enhanced her left-ventricular ejection fraction (LVEF) from 22% to 40%. Five days after TAVI, ECMO was replaced by intra-aortic balloon pumping (IABP) and it was removed 3 days later. A minor complication of this therapy, e.g., muscular weakness in her left leg, was noted. The patient underwent rehabilitation for about 2 months, and was discharged from hospital with a wheel chair and clear consciousness. At the 24 month follow-up she was in good recovery and was able to walk upstairs to the second floor again. Our experience suggests that one indication of prophylactic use of ECMO is for patients with an unstable hemodynamic condition.
经导管主动脉瓣植入术（TAVI）已成为严重主动脉瓣狭窄和围手术期高风险患者的首选治疗方法。心源性休克是 TAVI 过程中最严重的并发症之一，尤其是继发于主动脉瓣狭窄的心源性休克预后极差。这种情况可能具有挑战性，而体外膜肺氧合（ECMO）可以作为一种治疗选择。在这里，我们报告了一位 88 岁女性患者的病例，该患者被诊断为非 ST 段抬高型心肌梗死（NSTEMI）和严重的主动脉瓣狭窄（AS），Logistic Euroscore 为 25%。经皮冠状动脉介入治疗（PCI）顺利进行，在 TAVI 手术开始时出现心动过速-心动过缓性房颤伴快速性心律失常，继而发生心脏骤停。在她的左股侧安装了 v-a ECMO。此后，相应地完成了 TAVI 手术；她的意识恢复，左心室射血分数（LVEF）从 22%提高到 40%。TAVI 后 5 天，ECMO 被主动脉内球囊反搏（IABP）取代，3 天后被移除。该治疗方法的一个轻微并发症是她左腿肌肉无力。患者接受了大约 2 个月的康复治疗，出院时乘坐轮椅，意识清醒。在 24 个月的随访中，她恢复良好，能够再次走上二楼。我们的经验表明，预防性使用 ECMO 的一个适应证是对血流动力学不稳定的患者。
