Department of Cardiothoracic Surgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany.
Department of Cardiology, Heart Center, University Hospital of Cologne, Cologne, Germany.
Thorac Cardiovasc Surg. 2023 Mar;71(2):101-106. doi: 10.1055/s-0042-1750304. Epub 2022 Jul 19.
Transcatheter aortic valve replacement (TAVR) has become an established alternative to surgical aortic valve replacement (AVR) for higher risk patients. Periprocedural TAVR complications decreased with a growing expertise of implanters. Yet, TAVR can be accompanied by life-threatening adverse events such as intraprocedural cardiopulmonary resuscitation (CPR). This study retrospectively analyzed predictors and outcomes in a cohort of patients from a high-volume center undergoing periprocedural CPR during TAVR.
A total of 729 patients undergoing TAVR, including 59 with intraprocedural CPR, were analyzed with respect to peri- and postprocedural outcomes.
Patients undergoing CPR showed a significantly lower left ventricular ejection fraction (LVEF) and lower baseline transvalvular mean and peak pressure gradients. The systolic blood pressure measured directly preoperatively was significantly lower in the CPR cohort. CPR patients were in a higher need for intraprocedural defibrillation, heart-lung circulatory support, and conversion to open heart surgery. Further, they showed a higher incidence of atrioventricular block grade III , valve malpositioning, and pericardial tamponade. The in-hospital mortality was significantly higher after intraprocedural CPR, accompanied by a higher incidence of disabling stroke, new pacemaker implantation, more red blood cell transfusion, and longer stay in intensive care unit.
Impaired preoperative LVEF and instable hemodynamics before valve deployment are independent risk factors for CPR and are associated with compromised outcomes. Heart rhythm disturbances, malpositioning of the prosthesis, and pericardial tamponade are main causes of the high mortality of 17% reported in the CPR group. Nevertheless, mechanical circulatory support and conversion to open heart surgery reduce mortality rates of CPR patients.
经导管主动脉瓣置换术（TAVR）已成为高危患者外科主动脉瓣置换术（AVR）的替代方法。随着植入者专业知识的不断提高，围手术期 TAVR 并发症有所减少。然而，TAVR 可能伴随着危及生命的不良事件，如术中心肺复苏（CPR）。本研究回顾性分析了高容量中心行 TAVR 术中发生围手术期 CPR 的患者队列的预测因素和结局。
共分析了 729 例行 TAVR 的患者，其中 59 例发生术中 CPR，分析了围手术期和术后结局。
行 CPR 的患者左心室射血分数（LVEF）明显降低，术前跨瓣平均和峰值压力梯度也明显降低。CPR 组术前直接测量的收缩压明显较低。CPR 患者术中更需要除颤、心肺循环支持和转为开胸手术。此外，他们的三度房室传导阻滞、瓣膜错位和心包填塞发生率更高。术中行 CPR 后院内死亡率明显升高，同时伴有较高的致残性中风、新起搏器植入、更多的红细胞输注和更长的 ICU 停留时间。
术前 LVEF 受损和瓣膜植入前血流动力学不稳定是行 CPR 的独立危险因素，与预后不良有关。心律紊乱、假体位置不当和心包填塞是 CPR 组报告的 17%高死亡率的主要原因。然而，机械循环支持和转为开胸手术降低了 CPR 患者的死亡率。
