Lesbekov Timur, Mussayev Abdurashid, Alimbayev Serik, Kaliyev Rymbay, Kuanyshbek Aidyn, Faizov Linar, Nurmykhametova Zhuldyz, Kunakbayeva Aigerim, Sadykova Aigerim
Department of Adult Cardiac Surgery, National Research Cardiac Surgery Center, Astana 020000, Kazakhstan.
Department of Interventional Cardiology, National Research Cardiac Surgery Center, Astana 020000, Kazakhstan.
J Clin Med. 2023 Jan 20;12(3):859. doi: 10.3390/jcm12030859.
TAVR remains a complex procedure that may result in serious intraprocedural complications. In many of these circumstances, venoarterial extracorporeal membrane oxygenation (V-A ECMO) helps to manage complications, provides a hemodynamic back-up, and bridges to an emergency open heart surgery. The clinical outcomes of 27 patients who underwent prophylactic implantation of peripheral V-A ECMO (pV-A ECMO) during high-risk transcatheter aortic valve replacement (TAVR) cases are described.
From June 2012 to October 2022, 590 consecutive patients underwent TAVR at our center. Of these, 27 patients (4.5%) underwent TAVR with pV-AECMO because they were deemed very high risk for periprocedural complications and formed the study population.
There were no pV-A ECMO, hemodynamic or TAVR implantation complications. Decannulation of the ECMO system was performed in 92.6% of cases at the end of the procedure in the hybrid-operating theatre. The mean duration of pV-A ECMO for procedure support was 51.4 ± 10.3 min. There were no ECMO-related vascular or bleeding complications.
This study shows that the prophylactic placement of awake peripheral V-A ECMO provides excellent temporary cardio-circulatory and pulmonary support during very high-risk TAVR procedures.
经导管主动脉瓣置换术（TAVR）仍是一项复杂的手术，可能会导致严重的术中并发症。在许多此类情况下，静脉-动脉体外膜肺氧合（V-A ECMO）有助于处理并发症，提供血流动力学支持，并为紧急心脏直视手术提供过渡。本文描述了27例在高危经导管主动脉瓣置换术（TAVR）中接受预防性植入外周V-A ECMO（pV-A ECMO）患者的临床结果。
2012年6月至2022年10月，连续590例患者在本中心接受TAVR。其中，27例患者（4.5%）因被认为围手术期并发症风险极高而在TAVR术中接受了pV-A ECMO植入，这些患者构成了研究人群。
未发生pV-A ECMO、血流动力学或TAVR植入相关并发症。92.6%的病例在杂交手术室手术结束时拔除了ECMO系统导管。pV-A ECMO用于手术支持的平均持续时间为51.4±10.3分钟。未发生与ECMO相关的血管或出血并发症。
本研究表明，在极高风险的TAVR手术中，预防性植入清醒外周V-A ECMO可提供出色的临时心肺循环和肺部支持。
