VA-ECMO在主动脉瓣狭窄介入治疗中的置管策略

张波; 吴东峰; 邓金龙; 廖钦晨

doi:10.13201/j.issn.1001-1439.2023.11.004

VA-ECMO在主动脉瓣狭窄介入治疗中的置管策略

- 广西医学科学院·广西壮族自治区人民医院老年心内科(南宁，530000)
基金项目:
广西壮族自治区卫生健康委科研课题(No：Z-A20230126)

详细信息

通讯作者: 廖钦晨，E-mail：448217388@qq.com

中图分类号: R542.5

收稿日期: 2022-12-07

刊出日期: 2023-11-13

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

- Department of Geriatric Cardiology, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530000, China

More Information

Corresponding author: LIAO Qinchen, E-mail: 448217388@qq.com

Received Date: 07 December 2022

Publish Date: 13 November 2023

摘要

摘要: 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。
- 主动脉瓣狭窄 /
- 体外膜肺氧合 /
- 经导管主动脉瓣置换术 /
- 置管策略
Abstract: 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.
- aortic stenosis /
- extracorporeal membranous oxygenator /
- transcatheter aortic valve replacement /
- pipe placement mode

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参考文献(32)

[1]	刘坤, 李裕舒, Chorianopoulos E, 等. 经导管主动脉瓣植入术研究进展[J]. 临床心血管病杂志, 2016, 32(10): 967-968. https://lcxxg.whuhzzs.com/article/doi/10.13201/j.issn.1001-1439.2016.10.001
[2]	Van Mieghem NM, Deeb GM, Sondergaard L, et al. Self-expanding Transcatheter vs Surgical Aortic Valve Replacement in Intermediate-Risk Patients: 5-Year Outcomes of the SURTAVI Randomized Clinical Trial[J]. JAMA Cardiol, 2022, 7(10): 1000-1008. doi: 10.1001/jamacardio.2022.2695
[3]	Nguyen TC, Terwelp MD, Thourani VH, et al. Clinical trends in surgical, minimally invasive and transcatheter aortic valve replacementdagger[J]. Eur J Cardiothorac Surg, 2017, 51(6): 1086-1092. doi: 10.1093/ejcts/ezx008
[4]	Malaisrie SC, Iddriss A, Flaherty JD, et al. Transcatheter Aortic Valve Implantation[J]. Curr Atheroscler Rep, 2016, 18(5): 27. doi: 10.1007/s11883-016-0577-2
[5]	Makdisi G, Makdisi PB, Wang IW. Use of extracorporeal membranous oxygenator in transcatheter aortic valve replacement[J]. Ann Transl Med, 2016, 4(16): 306. doi: 10.21037/atm.2016.08.14
[6]	Rahhab Z, El FN, Tchetche D, et al. Expanding the indications for transcatheter aortic valve implantation[J]. Nat Rev Cardiol, 2020, 17(2): 75-84. doi: 10.1038/s41569-019-0254-6
[7]	李光照, 王明蛟, 胡彩娜, 等. 经导管主动脉瓣置换术治疗重度主动脉瓣狭窄的初步临床疗效分析[J]. 临床心血管病杂志, 2020, 36(3): 280-283. https://lcxxg.whuhzzs.com/article/doi/10.13201/j.issn.1001-1439.2020.03.019
[8]	Ueshima D, Fovino LN, D'Amico G, et al. Transcatheter versus surgical aortic valve replacement in low-and intermediate-risk patients: an updated systematic review and meta-analysis[J]. Cardiovasc Interv Ther, 2019, 34(3): 216-225. doi: 10.1007/s12928-018-0546-5
[9]	Thourani VH, Edelman JJ, Holmes SD, et al. The International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on Transcatheter and Surgical Aortic Valve Replacement in Low-and Intermediate-Risk Patients: A Meta-Analysis of Randomized and Propensity-Matched Studies[J]. Innovations(Phila), 2021, 16(1): 3-16. doi: 10.1177/1556984520978316
[10]	Avvedimento M, Tang G. Transcatheter aortic valve replacement(TAVR): Recent updates[J]. Prog Cardiovasc Dis, 2021, 69: 73-83. doi: 10.1016/j.pcad.2021.11.003
[11]	Karycki MK. Transcatheter aortic valve replacement[J]. Nursing, 2019, 49(6): 24-31. doi: 10.1097/01.NURSE.0000558086.92851.51
[12]	Marchese A, Tarantini G, Tito A, et al. Mechanical circulatory support and intravascular lithotripsy in high-risk patients undergoing percutaneous coronary intervention and transcatheter aortic valve replacement: a case series[J]. Eur Heart J Case Rep, 2021, 5(12): b498. doi: 10.1093/ehjcr/ytab498
[13]	Shou BL, Verma A, Florissi IS, et al. Temporary Mechanical Circulatory Support for Transcatheter Aortic Valve Replacement[J]. J Surg Res, 2022, 280: 363-370. doi: 10.1016/j.jss.2022.07.034
[14]	Kmiec L, Holzamer A, Fischer M, et al. Protected complex percutaneous coronary intervention and transcatheter aortic valve replacement using extracorporeal membrane oxygenation in a high-risk frail patient: a case report[J]. J Med Case Rep, 2020, 14(1): 163. doi: 10.1186/s13256-020-02474-x
[15]	Okada T, Yoshida T, Makino S, et al. Anesthetic Management of Transcatheter Aortic Valve Replacement under Extracorporeal Membrane Oxygenation in a Patient with Acute Decompensated Heart Failure: A Case Report[J]. Kobe J Med Sci, 2019, 65(3): E90-E94.
[16]	Cianchi G, Lazzeri C, Bonizzoli M, et al. Echo-Guided Insertion of a Dual-Lumen Cannula for Venovenous Extracorporeal Membrane Oxygenation[J]. ASAIO J, 2019, 65(4): 414-416. doi: 10.1097/MAT.0000000000000826
[17]	Whittaker D, Edmunds C, Scott I, et al. Rib fracture fixation in a patient on veno-venous ECMO for severe blunt thoracic trauma[J]. Ann R Coll Surg Engl, 2021, 103(9): e269-e271. doi: 10.1308/rcsann.2020.7108
[18]	Ogawa F, Sakai T, Takahashi K, et al. A case report: Veno-venous extracorporeal membrane oxygenation for severe blunt thoracic trauma[J]. J Cardiothorac Surg, 2019, 14(1): 88. doi: 10.1186/s13019-019-0908-9
[19]	Karatolios K, Chatzis G, Markus B, et al. Comparison of mechanical circulatory support with venoarterial extracorporeal membrane oxygenation or Impella for patients with cardiogenic shock: a propensity-matched analysis[J]. Clin Res Cardiol, 2020, 110(9): 1404-1411.
[20]	Raptis DA, Beal MA, Kraft DC, et al. Transcatheter Aortic Valve Replacement: Alternative Access beyond the Femoral Arterial Approach[J]. Radiographics, 2019, 39(1): 30-43. doi: 10.1148/rg.2019180059
[21]	Reardon MJ, Van Mieghem NM, Popma JJ, et al. Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients[J]. N Engl J Med, 2017, 376(14): 1321-1331. doi: 10.1056/NEJMoa1700456
[22]	Bonaros N, Petzina R, Cocchieri R, et al. Transaortic transcatheter aortic valve implantation as a first-line choice or as a last resort? An analysis based on the ROUTE registry[J]. Eur J Cardiothorac Surg, 2017, 51(5): 919-926. doi: 10.1093/ejcts/ezw406
[23]	Chamandi C, Abi-Akar R, Rodes-Cabau J, et al. Transcarotid Compared With Other Alternative Access Routes for Transcatheter Aortic Valve Replacement[J]. Circ Cardiovasc Interv, 2018, 11(11): e6388.
[24]	Folliguet TA, Teiger E, Beurtheret S, et al. Carotid versus femoral access for transcatheter aortic valve implantation: a propensity score inverse probability weighting study[J]. Eur J Cardiothorac Surg, 2019, 56(6): 1140-1146. doi: 10.1093/ejcts/ezz216
[25]	Hysi I, Gommeaux A, Pecheux M, et al. Axillary Transcatheter Aortic Valve Replacement in Patients With Peripheral Vascular Disease[J]. Semin Thorac Cardiovasc Surg, 2019, 31(2): 175-180. doi: 10.1053/j.semtcvs.2018.09.016
[26]	Testa L, Brambilla N, Laudisa ML, et al. Right subclavian approach as a feasible alternative for transcatheter aortic valve implantation with the CoreValve ReValving System[J]. EuroIntervention, 2012, 8(6): 685-690. doi: 10.4244/EIJV8I6A107
[27]	Biasco L, Ferrari E, Pedrazzini G, et al. Access Sites for TAVI: Patient Selection Criteria, Technical Aspects, and Outcomes[J]. Front Cardiovasc Med, 2018, 5: 88. doi: 10.3389/fcvm.2018.00088
[28]	Auffret V, Lefevre T, Van Belle E, et al. Temporal Trends in Transcatheter Aortic Valve Replacement in France: FRANCE 2 to FRANCE TAVI[J]. J Am Coll Cardiol, 2017, 70(1): 42-55. doi: 10.1016/j.jacc.2017.04.053
[29]	Blackstone EH, Suri RM, Rajeswaran J, et al. Propensity-matched comparisons of clinical outcomes after transapical or transfemoral transcatheter aortic valve replacement: a placement of aortic transcatheter valves(PARTNER)-I trial substudy[J]. Circulation, 2015, 131(22): 1989-2000. doi: 10.1161/CIRCULATIONAHA.114.012525
[30]	Al-Attar N, Raffoul R, Himbert D, et al. False aneurysm after transapical aortic valve implantation[J]. J Thorac Cardiovasc Surg, 2009, 137(1): e21-e22. doi: 10.1016/j.jtcvs.2008.07.018
[31]	Overtchouk P, Modine T. A comparison of alternative access routes for transcatheter aortic valve implantation[J]. Expert review of cardiovascular therapy, 2018, 16(10): 749-756. doi: 10.1080/14779072.2018.1524295
[32]	Romano M, Frank D, Cocchieri R, et al. Transaortic transcatheter aortic valve implantation using SAPIEN XT or SAPIEN 3 valves in the ROUTE registry[J]. Interact Cardiovasc Thorac Surg, 2017, 25(5): 757-764. doi: 10.1093/icvts/ivx159