Catastrophic Cardiac Events During Transcatheter Aortic Valve Replacement.
Catastrophic Cardiac Events During Transcatheter Aortic Valve Replacement.
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DOI：
10.1016/j.cjca.2021.05.002
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发表时间：
2021-10
期刊：
影响因子：
--
通讯作者：
Eltzschig H
中科院分区：
文献类型：
--
作者：
Liang Y;Dhoble A;Pakanati A;Zhao Y;Kork F;Ruan W;Markham T;Smalling R;Balan P;Estrera A;Nguyen TC;Gregoric I;Kar B;Eltzschig H
经导管主动脉瓣置换术(TAVR)的围术期并发症正在减少，但一旦发生，可能是灾难性的。在当代，对这些事件的性质缺乏系统的报道。我们的研究旨在报告接受TAVR的患者中灾难性心脏事件的发生率、结果和围手术期处理，并提出解决这些并发症的工作策略。这是一项回顾性队列研究，研究对象是在2015年至2019年期间在单一学术中心进行TAVR期间或之后立即发生灾难性心脏事件的患者。在接受TAVR的2102名患者中，51名(2.5%)发生了灾难性的心脏事件。病因包括心脏穿孔和填塞19例(37.3%)，急性左心衰竭10例(19.6%)，冠状动脉阻塞10例(19.6%)，主动脉根部破裂7例(13.7%)，装置栓塞术5例(9.8%)。有灾难性心脏事件的24名患者(47.0%)需要通过主动脉内球囊反搏或体外膜氧合稳定下来。有灾难性心脏事件的患者的住院死亡率比没有发生灾难性心脏事件的患者高11.7倍(25.5%比2.0%，p<；0.001)。发生主动脉根部破裂的患者病死率最高(42.8%)。灾难性心脏事件的发生率在5年内保持稳定，但相关死亡率从2015年的38.5%下降到2019年的9.1%。TAVR期间的灾难性心脏事件很少见，但它们会导致围手术期死亡率的急剧增加。及早认识和发展标准化的围手术期团队方法可以帮助患者处理这些并发症。在这项大规模、单中心、回顾性队列研究中，我们确定了经导管主动脉瓣置换术围术期灾难性心脏事件的发生率为2.5%，相关的住院死亡率为25.5%。灾难性心脏事件最常见的原因是心脏穿孔和填塞，其次是急性左心衰竭、冠状动脉阻塞、主动脉根部破裂和装置栓塞。我们提出了一种标准化的方法算法来早期识别和处理这些并发症。
Perioperative complications of transcatheter aortic valve replacement (TAVR) are decreasing but can be catastrophic when they occur. Systematic reports of the nature of these events are lacking in the contemporary era. Our study aimed to report the incidence, outcomes, and perioperative management of catastrophic cardiac events in patients undergoing TAVR and to propose a working strategy to address these complications. This is a retrospective cohort study of patients who developed catastrophic cardiac events during or immediately after TAVR between 2015 and 2019 at a single academic center. Of 2102 patients who underwent TAVR, 51 (2.5%) developed catastrophic cardiac events. The causes included cardiac perforation and tamponade (n=19, 37.3%), acute left ventricular failure (n=10, 19.6%), coronary artery obstruction (n=10, 19.6%), aortic root disruption (7, 13.7%), and device embolization (n=5, 9.8%). Twenty-four patients (47.0%) with catastrophic cardiac events required stabilization by either intra-aortic balloon counter-pulsation or extracorporeal membrane oxygenation. The in-hospital mortality rate increased by 11.7-fold for patients with catastrophic cardiac events compared to those without (25.5% vs 2.0%, p<0.001). Patients who developed aortic root disruption had the highest mortality rate (42.8%) compared with the others. The incidence of catastrophic cardiac events remained stable over a 5-year period, but the associated mortality decreased from 38.5% in 2015 to 9.1% in 2019. Catastrophic cardiac events during TAVR are rare, but they account for a dramatic increase in perioperative mortality. Early recognition and development of a standardized perioperative team approach can help manage patients experiencing these complications. In this large-scale, single-center, retrospective cohort study, we determined the incidence of peri-procedural catastrophic cardiac events to be 2.5% with an associated in-hospital mortality rate of 25.5% during transcatheter aortic valve replacement. The most common cause of catastrophic cardiac events was cardiac perforation and tamponade, followed by acute left ventricular failure, coronary artery obstruction, aortic root disruption, and device embolization. We propose a standardized approach algorithm for the early recognition and management of these complications.
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