左心室射血分数降低的患者体外膜肺氧合辅助下经导管主动脉瓣置换术的效果

Extracorporeal membrane oxygenation support during transcatheter aortic valve replacement in patients with reduced left ventricular ejection fraction

目的探讨左心室射血分数(LVEF)降低患者在体外膜肺氧合(ECMO)辅助下经导管主动脉瓣置换术(TAVR)的疗效。方法本研究为单中心、回顾性研究,入选2020年1月至2024年1月中国人民解放军空军军医大学第一附属医院心血管内科经过心脏团队评估高危主动脉瓣狭窄和(或)主动脉瓣关闭不全合并LVEF≤30%的TAVR患者30例,其中12例在ECMO辅助下行TAVR术(预置入ECMO组),18例未在ECMO辅助下行TAVR术(未置入ECMO组)。收集患者基线资料,术中情况和随访30 d、6个月的不良事件。结果30例患者中男20例,平均年龄(67.0±10.4)岁,平均STS评分为(8.2±1.8)分,平均LVEF(21.2±5.3)%。本研究共纳入AR患者11例,均见于未置入ECMO组,两组比较差异有统计学意义(P=0.027)。术中预置入ECMO组循环崩溃[0比5(5/18),P=0.037]、抢救性ECMO置入比例[0比5(5/18),P=0.037]均显著低于未置入ECMO组比较,差异均有统计学意义。30例患者技术成功率为76.7%(23/30),器械成功率为60.0%(18/30)。其中,预置入ECMO组技术成功率、器械成功率均高于未置入ECMO组,但差异均无统计学意义(均P>0.05)。30 d随访,预置入ECMO组全因死亡[0比9(9/18),P=0.012],其中心血管原因死亡[0比7(7/18),P=0.024]均显著低于未置入ECMO组,差异均有统计学意义。随访6个月,预置入ECMO组全因死亡率[1(1/12)1/12比9(9/18),P=0.024]显著低于未置入ECMO组,差异有统计学意义。预置入ECMO组脑卒中发生率为1/12(8.3%),未置入ECMO组为0,两组相比,差异无统计学意义(P=0.978)。结论低LVEF值患者行TAVR术中出现循环崩溃的发生率较高,ECMO辅助可降低术中循环崩溃风险,提高围术期生存率。

Objective To evaluate the efficacy of extracorporeal membrane oxygenation(ECMO)in patients with reduced left ventricular ejection fraction(LVEF)undergoing transcatheter aortic valve implantation(TAVR).Methods This was a single-center,retrospective study enrolling a total of 30 patients with reduced LVEF undergoing TAVR from January 2020 to January 2024.Of these,12 patients underwent TAVR with ECMO.Baseline clinical characteristics,preprocedural 11echocardiographic and computed tomographic(CT)measurements,TAVR procedural details,and follow-up data at 60-day and 6-month were collected.Results Among the 30 patients,there were 20 males with an average age of(67.0±10.4)years,an average STS score of(8.2±1.8)points,and an average LVEF of(21.2±5.3)%.This study included 11 AR patients,all of whom were in the group without ECMO implantation,and the diff erence between the two groups was statistically signifi cant(P=0.027).During the operation,there were 0 cases of circulatory collapse in the ECMO group,and 5 cases(5/18)of circulatory collapse in the non ECMO group.All 5 patients underwent emergency ECMO placement.There were statistically significant differences(P<0.05)in the comparison of two groups with circulatory collapse and salvage ECMO implantation.The technical success rate of 30 patients was 76.7%(23/30),and the instrument success rate was 60.0%(18/30).Among them,the technical success rate and instrument success rate of the ECMO group were higher than those of the non ECMO group,but the diff erences were not statistically signifi cant(both P>0.05).During a 30 day follow-up,there were 0 all-cause deaths in the ECMO group and 9 all-cause deaths(9/18)in the non ECMO group.Among them,7 cases(7/18)died from cardiovascular causes.The differences in all-cause and cardiovascular cause deaths between the two groups were statistically signifi cant(both P<0.05).During a 6-month follow-up,one patient with ECMO died due to extensive cerebral infarction.The all-cause mortality rate during the 6-month follow-up was 1/12(8.3%),while the all-cause mortality rate without ECMO was 9/18(5.0%).The difference between the two groups was statistically signifi cant(P=0.024).The incidence of stroke with ECMO was 1/12(8.3%),while without ECMO it was 0.There was no statistically significant difference between the two groups(P=0.978).Conclusions In patients with reduced LVEF undergoing TAVR,periprocedural ECMO support does seem to improve patient outcome.