Extracorporeal membrane oxygenation support during transcatheter aortic valve replacement in patients with reduced left ventricular ejection fraction
10.3969/j.issn.1004-8812.2024.11.006
- VernacularTitle: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
- Author:
Cun-Jun ZHU
1
;
Chao GAO
;
Bo WANG
;
Tao SU
;
Ru-Tao WANG
;
Yuan HE
;
Fang-Jun MOU
;
Xiao-Na CHEN
;
Fei LI
;
Ling TAO
Author Information
1. 中国人民解放军空军军医大学第一附属医院心血管内科,陕西西安 710032
- Keywords:
Aortic valve disease;
High surgical risk;
Reduced left ventricular ejection fraction;
Transcatheter aortic valve replacement;
Extracorporeal membrane oxygenation
- From:
Chinese Journal of Interventional Cardiology
2024;32(11):642-647
- CountryChina
- Language:Chinese
-
Abstract:
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 echocardiographic 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 difference between the two groups was statistically significant(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 differences were not statistically significant(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 significant(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 significant(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.
