Severe aortic stenosis treated by emergency transcatheter aortic valve replacement after extracorporeal cardiopulmonary resuscitation: a case report_West China Medical Journal

Authors：

XU Chengyi ¹ , ZHANG Longyan ¹ , GUO Hui ¹ , SONG Dan ¹ , WANG Bo ² , HUA Zhengdong ² ,  SU Xi ¹ , HE Yafeng ³

1. Cardiology Department, Wuhan Asia Heart Hospital, Wuhan, Hubei 430022, P. R. China;
2. Cardiac Surgery Department, Wuhan Asia Heart Hospital, Wuhan, Hubei 430022, P. R. China;
3. Ultrasound Department, Wuhan Asia Heart Hospital, Wuhan, Hubei 430022, P. R. China;

Corresponding?author：

SU Xi, Email: yaxin_suxi@163.com

Keywords：

Extracorporeal membrane oxygenation; Extracorporeal cardiopulmonary resuscitation; Aortic stenosis; Transcatheter aortic valve replacement

DOI：

10.7507/1002-0179.202002387

Video：

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A 69-year-old male was presented with exercise intolerance and progressive exertional dyspnea for 3 months. His main clinical diagnosis were degenerative valvular disease, severe aortic stenosis, severe aortic regurgitation, severe mitral regurgitation, severe tricuspid regurgitation, ventricular electrical storm, chronic heart failure, and New York Heart Association (NYHA) class Ⅳ heart function. He was encountered with sudden ventricular electrical storm in the emergency room. Extracorporeal membrane oxygenation (ECMO) was impanted beside during cardiopulmonary resuscitation. Emergency transcatheter aortic valve replacement (TAVR) was successfully performed under the guidance of transesophageal echocardiography when hemodynamics permitted. ECMO was withdrawn on the 5th day and discharged on the 21st day. TAVR is safe and effective for the treatment of high-risk aortic stenosis, and ECMO support is the key for the success of cardiopulmonary resuscitation.

Citation： XU Chengyi, ZHANG Longyan, GUO Hui, SONG Dan, WANG Bo, HUA Zhengdong, SU Xi, HE Yafeng. Severe aortic stenosis treated by emergency transcatheter aortic valve replacement after extracorporeal cardiopulmonary resuscitation: a case report. West China Medical Journal, 2020, 35(4): 412-417. doi: 10.7507/1002-0179.202002387 Copy

1.	徐承義, 蘇晞, 宋丹, 等. 體外膜肺氧合成功搶救碘帕醇對比劑致過敏性休克1例的體會. 內科急危重癥雜志, 2014, 20(5): 355-356, 360.
2.	Iung B, Cachier A, Baron G, et al. Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery?. Eur Heart J, 2005, 26(24): 2714-2720.
3.	中國醫師協會心血管內科醫師分會結構性心臟病專業委員, 中華醫學會心血管病學分會結構性心臟病學組. 經導管主動脈瓣置換術中國專家共識. 中國介入心臟病學雜志, 2015, 23(12): 661-667.
4.	陳鵬飛, 胡信群, 方臻飛. 如何治療主動脈瓣狹窄合并體外膜肺氧合支持下的心源性休克. 華西醫學, 2018, 33(2): 223-229.
5.	陸蓮, 方濱. 體外膜肺氧合成功治療主動脈瓣置換術后低心排出量綜合征1例報道. 現代醫藥衛生, 2015, 31(16): 2566-2568.
6.	金屏, 劉洋, 唐嘉佑, 等. 體外膜肺氧合輔助下經導管主動脈瓣置換術的臨床應用研究. 精準醫學雜志, 2018, 33(2): 110-114.
7.	楊力凡, 潘文志, 賴浩, 等. 體外膜肺氧合支持下治療重度主動脈瓣狹窄一例. 中華心血管病雜志, 2019, 47(11): 913-915.
8.	Huang J, Chen P, Hu X, et al. Aortic stenosis complicated by cardiogenic shock treated by transcatheter aortic valve replacement with extracorporeal membrane oxygenation: a case report. Medicine (Baltimore), 2018, 97(33): e11900.
9.	劉洋, 丁鵬, 程亮, 等. 體外膜肺氧合輔助經導管主動脈瓣植入治療極低射血分數值的重度主動脈瓣狹窄. 中國體外循環雜志, 2019, 17(1): 13-17.
10.	Neumar RW, Shuster M, Callaway CW, et al. Part 1: executive summary: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2015, 132(18 Suppl 2): S315-S367.
11.	Ahn C, Kim W, Cho Y, et al. Efficacy of extracorporeal cardiopulmonary resuscitation compared to conventional cardiopulmonary resuscitation for adult cardiac arrest patients: a systematic review and meta-analysis. Sci Rep, 2016, 6: 34208.
12.	Rubertsson S, Lindgren E, Smekal D, et al. Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the LINC randomized trial. JAMA, 2014, 311(1): 53-61.
13.	Esibov A, Banville I, Chapman FW, et al. Mechanical chest compressions improved aspects of CPR in the LINC trial. Resuscitation, 2015, 91: 116-121.
14.	Banjac I, Petrovic M, Akay MH, et al. Extracorporeal membrane oxygenation as a procedural rescue strategy for transcatheter aortic valve replacement cardiac complications. ASAIO J, 2016, 62(1): e1-e4.
15.	Singh V, Damluji AA, Mendirichaga R, et al. Elective or emergency use of mechanical circulatory support devices during transcatheter aortic valve replacement. J Interv Cardiol, 2016, 29(5): 513-522.
16.	Raffa GM, Kowalewski M, Meani P, et al. In-hospital outcomes after emergency or prophylactic veno-arterial extracorporeal membrane oxygenation during transcatheter aortic valve implantation: a comprehensive review of the literature. Perfusion, 2019, 34(5): 354-363.
17.	Uehara K, Minakata K, Saito N, et al. Use of extracorporeal membrane oxygenation in complicated transcatheter aortic valve replacement. Gen Thorac Cardiovasc Surg, 2017, 65(6): 329-336.
18.	Dolmatova E, Moazzami K, Cocke TP, et al. Extracorporeal membrane oxygenation in transcatheter aortic valve replacement. Asian Cardiovasc Thorac Ann, 2017, 25(1): 31-34.
19.	Satler L, Thourani VH. Who can we save after an intraprocedural catastrophe during TAVR?. Catheter Cardiovasc Interv, 2018, 92(1): 157-158.
20.	Tr?ger K, Schütz C, Fischer G, et al. Cytokine reduction in the setting of an ARDS-associated inflammatory response with multiple organ failure. Case Rep Crit Care, 2016, 2016: 9852073.

1. 徐承義, 蘇晞, 宋丹, 等. 體外膜肺氧合成功搶救碘帕醇對比劑致過敏性休克1例的體會. 內科急危重癥雜志, 2014, 20(5): 355-356, 360.
2. Iung B, Cachier A, Baron G, et al. Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery?. Eur Heart J, 2005, 26(24): 2714-2720.
3. 中國醫師協會心血管內科醫師分會結構性心臟病專業委員, 中華醫學會心血管病學分會結構性心臟病學組. 經導管主動脈瓣置換術中國專家共識. 中國介入心臟病學雜志, 2015, 23(12): 661-667.
4. 陳鵬飛, 胡信群, 方臻飛. 如何治療主動脈瓣狹窄合并體外膜肺氧合支持下的心源性休克. 華西醫學, 2018, 33(2): 223-229.
5. 陸蓮, 方濱. 體外膜肺氧合成功治療主動脈瓣置換術后低心排出量綜合征1例報道. 現代醫藥衛生, 2015, 31(16): 2566-2568.
6. 金屏, 劉洋, 唐嘉佑, 等. 體外膜肺氧合輔助下經導管主動脈瓣置換術的臨床應用研究. 精準醫學雜志, 2018, 33(2): 110-114.
7. 楊力凡, 潘文志, 賴浩, 等. 體外膜肺氧合支持下治療重度主動脈瓣狹窄一例. 中華心血管病雜志, 2019, 47(11): 913-915.
8. Huang J, Chen P, Hu X, et al. Aortic stenosis complicated by cardiogenic shock treated by transcatheter aortic valve replacement with extracorporeal membrane oxygenation: a case report. Medicine (Baltimore), 2018, 97(33): e11900.
9. 劉洋, 丁鵬, 程亮, 等. 體外膜肺氧合輔助經導管主動脈瓣植入治療極低射血分數值的重度主動脈瓣狹窄. 中國體外循環雜志, 2019, 17(1): 13-17.
10. Neumar RW, Shuster M, Callaway CW, et al. Part 1: executive summary: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2015, 132(18 Suppl 2): S315-S367.
11. Ahn C, Kim W, Cho Y, et al. Efficacy of extracorporeal cardiopulmonary resuscitation compared to conventional cardiopulmonary resuscitation for adult cardiac arrest patients: a systematic review and meta-analysis. Sci Rep, 2016, 6: 34208.
12. Rubertsson S, Lindgren E, Smekal D, et al. Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the LINC randomized trial. JAMA, 2014, 311(1): 53-61.
13. Esibov A, Banville I, Chapman FW, et al. Mechanical chest compressions improved aspects of CPR in the LINC trial. Resuscitation, 2015, 91: 116-121.
14. Banjac I, Petrovic M, Akay MH, et al. Extracorporeal membrane oxygenation as a procedural rescue strategy for transcatheter aortic valve replacement cardiac complications. ASAIO J, 2016, 62(1): e1-e4.
15. Singh V, Damluji AA, Mendirichaga R, et al. Elective or emergency use of mechanical circulatory support devices during transcatheter aortic valve replacement. J Interv Cardiol, 2016, 29(5): 513-522.
16. Raffa GM, Kowalewski M, Meani P, et al. In-hospital outcomes after emergency or prophylactic veno-arterial extracorporeal membrane oxygenation during transcatheter aortic valve implantation: a comprehensive review of the literature. Perfusion, 2019, 34(5): 354-363.
17. Uehara K, Minakata K, Saito N, et al. Use of extracorporeal membrane oxygenation in complicated transcatheter aortic valve replacement. Gen Thorac Cardiovasc Surg, 2017, 65(6): 329-336.
18. Dolmatova E, Moazzami K, Cocke TP, et al. Extracorporeal membrane oxygenation in transcatheter aortic valve replacement. Asian Cardiovasc Thorac Ann, 2017, 25(1): 31-34.
19. Satler L, Thourani VH. Who can we save after an intraprocedural catastrophe during TAVR?. Catheter Cardiovasc Interv, 2018, 92(1): 157-158.
20. Tr?ger K, Schütz C, Fischer G, et al. Cytokine reduction in the setting of an ARDS-associated inflammatory response with multiple organ failure. Case Rep Crit Care, 2016, 2016: 9852073.

West China Medical Journal

Severe aortic stenosis treated by emergency transcatheter aortic valve replacement after extracorporeal cardiopulmonary resuscitation: a case report

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