VA-ECMO在主动脉瓣狭窄介入治疗中的置管策略

The catheterization strategy of VA-ECMO in the interventional treatment of aortic stenosis

主动脉瓣重度狭窄(aortic stenosis,AS)是老年人常见的原发性瓣膜病之一,外科手术风险高,预后极差。经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)是目前最优的微创化手术策略,但是存在外科手术禁忌,高危主动脉瓣疾病患者术中仍会有循环崩溃的可能,因此需要进一步的循环支持。体外膜肺氧合(extracorporeal membranous oxygenator,ECMO)是挽救高危AS患者TAVR术中及术后血流动力学不稳定的有效策略,但是TAVR及ECMO置管后引发的血管并发症不容忽视,需要更全面的血管入径评估。本文对目前TAVR治疗中常见的经股动脉入径、经颈动脉入径、经心尖入径、经主动脉入径等方式对ECMO置管策略的影响进行综述,以期为临床决策提供参考。

Severe aortic stenosis(AS) is one of common primary valvular diseases in the elderly population,characterized by high surgical risk and poor prognosis.Transcatheter aortic valve replacement(TAVR) stands as the current optimal minimally invasive surgical approach;however,surgical contraindications persist,and high-risk AS patients may still face the potential for circulatory collapse during the procedure.Consequently,additional circulatory support becomes imperative.Extracorporeal membrane oxygenation(ECMO) emerges as an effective strategy for rescuing high-risk AS patients with unstable hemodynamics during and after TAVR.Moreover,vascular complications arising from TAVR and ECMO should not be ignored,and more comprehensive evaluation on blood vessels entry approach is needed.Therefore,this paper reviewed the effect of the common vessels entry approaches in the treatment of TAVR on the choose ECMO,such as transfemoral artery approach,transcarotid approach,transapical approach and transaortic approach,to provide reference for clinical decision-making.