朱存军,高超,王博,苏涛,王汝涛,贺媛,牟方俊,陈晓娜,李飞,陶凌

• 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

摘要(Abstract)：

目的 探讨左心室射血分数（LVEF）降低患者在体外膜肺氧合（ECMO）辅助下经导管主动脉瓣置换术（TAVR）的疗效。方法 本研究为单中心、回顾性研究，入选2020年1月至2024年1月中国人民解放军空军军医大学第一附属医院心血管内科经过心脏团队评估高危主动脉瓣狭窄和（或）主动脉瓣关闭不全合并LVEF≤30%的TAVR患者30例，其中12例在ECMO辅助下行TAVR术（预置入ECMO组），18例未在ECMO辅助下行TAVR术（未置入ECMO组）。收集患者基线资料，术中情况和随访30 d、6个月的不良事件。结果 30例患者中男20例，平均年龄（67.0±10.4）岁，平均STS评分为（8.2±1.8）分，平均LVEF(21.2±5.3)%。本研究共纳入AR患者11例，均见于未置入ECMO组，两组比较差异有统计学意义（P=0.027）。术中预置入ECMO组循环崩溃[0比5(5/18),P=0.037]、抢救性ECMO置入比例[0比5(5/18),P=0.037]均显著低于未置入ECMO组比较，差异均有统计学意义。30例患者技术成功率为76.7%(23/30)，器械成功率为60.0%(18/30)。其中，预置入ECMO组技术成功率、器械成功率均高于未置入ECMO组，但差异均无统计学意义（均P>0.05）。30 d随访，预置入ECMO组全因死亡[0比9(9/18),P=0.012]，其中心血管原因死亡[0比7(7/18),P=0.024]均显著低于未置入ECMO组，差异均有统计学意义。随访6个月，预置入ECMO组全因死亡率[1(1/12)1/12比9(9/18),P=0.024]显著低于未置入ECMO组，差异有统计学意义。预置入ECMO组脑卒中发生率为1/12(8.3%)，未置入ECMO组为0，两组相比，差异无统计学意义（P=0.978）。结论 低LVEF值患者行TAVR术中出现循环崩溃的发生率较高，ECMO辅助可降低术中循环崩溃风险，提高围术期生存率。

关键词(KeyWords)： 主动脉瓣疾病;高手术风险;低左心室射血分数值;经导管主动脉瓣置换术;体外膜肺氧合

Abstract:

Keywords:

基金项目(Foundation): 国际科技合作计划项目（2023-GHYB-12）

作者(Author): 朱存军,高超,王博,苏涛,王汝涛,贺媛,牟方俊,陈晓娜,李飞,陶凌

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