预防性循环辅助在老年高危患者经导管主动脉瓣置换中的应用

Preventive Circulation Assistance in Transcatheter Aortic Valve Replacement in Elderly High-Risk Patients

摘要: 经导管主动脉瓣置换术(Transcatheter aortic valve replacement, TAVR)是一种新型的微创瓣膜置换技术，特别适用于存在外科手术禁忌证或外科手术高危的老年患者。经导管主动脉瓣置换术有多种并发症，若不引起重视，可能导致死亡。本例患者经综合分析，患者高龄且心肺功能较差，射血分数 ≤ 30%，慢性心功能不全加重，需及时手术干预，患者目前高危状态不适于外科手术，故经导管主动脉瓣置换是最有利于改善心衰，减轻心脏负荷的方案。经过多学科团队讨论，在取得患者及家属同意后，决定预防性体外膜肺氧合(Extracorporeal membrane oxygenation, ECMO)辅助下行经导管心脏瓣膜植入术。术中患者出现血压、心率骤降，循环崩溃，在手术团队的合作下成功抢救，及时处理，预后良好。

Abstract: Transcatheter aortic valve replacement (TAVR) is a novel minimally invasive valve replacement technique, especially suitable for elderly patients with contraindications to surgery or those at high risk for surgical procedures. Transcatheter aortic valve replacement has many complications, which may lead to death if not taken seriously. Through comprehensive analysis, this patient is elderly with poor cardiopulmonary function, ejection fraction ≤ 30%, and aggravated chronic heart failure, so timely surgical intervention is required. The patient is currently in a high-risk state and not suitable for surgery, so transcatheter aortic valve replacement is the most favorable plan to improve heart failure and reduce cardiac load. After multidisciplinary team deliberations and obtaining informed consent from the patient and family, a decision was made to perform transcatheter heart valve implantation with prophylactic extracorporeal membrane oxygenation (ECMO) support. During the procedure, the patient experienced a sudden drop in blood pressure and heart rate, leading to circulatory collapse. Through coordinated efforts by the surgical team, timely intervention was administered, resulting in a favorable prognosis.