经导管主动脉瓣植入术中心肺转流辅助效果分析  

Cardiopulmonary bypass in transcatheter aortic valve implantation

作　　者：江春景[1] 杨峰[1] 郝星[1] 郭冬[1] 徐博[1] 黑飞龙 侯晓彤[1] Jiang Chunjing;Yang Feng;Hao Xing;Guo Dong;Xu Bo;Hei Feilong;Hou Xiaotong(Department of Extracorporeal Circulation,Center for Cardiac Intensive Care,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科危重症中心,体外循环及机械辅助科室,北京100029

出　　处：《中国体外循环杂志》2024年第2期105-109,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的回顾本中心近些年经导管主动脉瓣植入(TAVI)和经心尖主动脉瓣置换(TAVR)术中接受心肺转流(CPB)的情况,以期为患者的救治提供经验。方法收集本中心自2019年1月至2021年12月TAVI和TAVR手术患者的资料,按结局把CPB患者分成死亡组和存活组。结果共收集348例TAVI和TAVR患者,男性占60.9%,平均年龄为(72±9)岁,总住院死亡率为13.5%。19例(5.5%)术中接受CPB辅助,其住院死亡率明显高于非CPB患者(42.1%vs.11.9%,P<0.05),术中心脏骤停并发症是主要原因;死亡组CPB建立时间明显长于生存组[(28±6)min vs.(21±3)min,P<0.01]。Logistic二元回归分析结果表明经心尖手术入路是术中接受CPB辅助的高风险因素;CPB建立时间的长短影响患者的结局。结论TAVI和TAVR中经心尖手术入路是术中接受CPB辅助的高风险因素,CPB患者具有更高的住院死亡率;完善的CPB策略可缩短CPB建立的时间从而降低住院死亡率。Objective This study systematically reviewed the experience of cardiopulmonary bypass(CPB)during transcatheter aortic valve implantation(TAVI)or transapical aortic valve replacement(TAVR)in our center in recent years,in order to provide experience for the treatment of patients.Methods The data of patients undergoing TAVI and TAVR surgery in our center from January 2019 to December 2021 were collected.CPB patients were divided into death group and survival group according to the outcome.Logistic analysis was used to analyze the factors affecting the outcome of CPB patients.Result A total of 348 patients with TAVI and TAVR were collected,of whom 60.9%were male,with an average age of 72±9 years.The in-hospital mortality was 13.5%.19 cases(5.5%)received CPB assistance during operation,and their in-hospital mortality was significantly higher than that of non CPB patients(42.1%vs 11.9%,P<0.05),The main reason of CPB was the complication of cardiac arrest in operation center;The CPB establishment time in the death group was significantly longer than that in the survival group(28±6min vs 21±3 min,P<0.01).The results of binary logistic regression analysis indicated that the apical approach was a high-risk factor for receiving CPB assistance during surgery,and the length of establishment time affected the outcome of CPB patients.Conclusion The TAVR transapical surgical approach is a high-risk factor for receiving CPB assistance during surgery,and CPB patients have a higher in-hospital mortality rate.A comprehensive CPB strategy can shorten the time for establishing CPB and thereby reduce in-hospital mortality.

关 键 词：心肺转流 经导管主动脉瓣植入术 策略 

分 类 号：R654.2[医药卫生—外科学]