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经导管主动脉瓣置换术并发症:急诊临床医生的叙述性综述。

Transcatheter aortic valve replacement complications: A narrative review for emergency clinicians.

机构信息

Department of Emergency Medicine, UC Davis Health, Sacramento, CA, United States.

Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States.

出版信息

Am J Emerg Med. 2022 Jun;56:77-86. doi: 10.1016/j.ajem.2022.03.042. Epub 2022 Mar 27.

Abstract

INTRODUCTION

Aortic valve stenosis (AS) is present in up to 10% of individuals over age 80 years. Transcatheter aortic valve replacement (TAVR) has become the most common method to replace the aortic valve in patients with AS. TAVR-related complications may occur.

OBJECTIVE

This narrative review evaluates the emergency department (ED) assessment and management of patients with TAVR complications.

DISCUSSION

Post-TAVR complications can be conceptualized as occurring peri-procedurally and after the peri-procedural period. Peri-procedural complications include device landing zone rupture, coronary artery obstruction, acute myocardial infarction, cardiac tamponade, and valve embolization. Complications beyond the peri-procedural window include vascular access/bleeding, mechanical valve issues, electrical conduction complications, and end-organ damage.

CONCLUSIONS

Emergency clinicians are more likely to encounter TAVR complications after the initial procedural hospitalization and must be prepared to diagnose and manage these complications.

摘要

简介

主动脉瓣狭窄(AS)在 80 岁以上的人群中发病率高达 10%。经导管主动脉瓣置换术(TAVR)已成为治疗 AS 患者主动脉瓣置换的最常见方法。TAVR 相关并发症可能会发生。

目的

本综述叙述性评估了 TAVR 并发症患者的急诊科评估和管理。

讨论

TAVR 术后并发症可分为手术期间和手术期间后发生。手术期间并发症包括器械着陆区破裂、冠状动脉阻塞、急性心肌梗死、心脏压塞和瓣膜栓塞。手术期间后并发症包括血管入路/出血、机械瓣问题、电传导并发症和终末器官损伤。

结论

急诊临床医生更有可能在初始手术住院后遇到 TAVR 并发症,必须做好诊断和处理这些并发症的准备。

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