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 ECMO was withdrawn on the 5th day and discharged on the 21st day.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.	徐承义, 苏晞, 宋丹, 等. 体外膜肺氧合成功抢救碘帕醇对比剂致过敏性休克1例的体会. 内科急危重症杂志, 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.	中国医师协会心血管内科医师分会结构性心脏病专业委员, 中华医学会心血管病学分会结构性心脏病学组. 经导管主动脉瓣置换术中国专家共识. 中国介入心脏病学杂志, 2015, 23(12): 661-667.
4.	陈鹏飞, 胡信群, 方臻飞. 如何治疗主动脉瓣狭窄合并体外膜肺氧合支持下的心源性休克. 华西医学, 2018, 33(2): 223-229.
5.	陆莲, 方滨. 体外膜肺氧合成功治疗主动脉瓣置换术后低心排出量综合征1例报道. 现代医药卫生, 2015, 31(16): 2566-2568.
6.	金屏, 刘洋, 唐嘉佑, 等. 体外膜肺氧合辅助下经导管主动脉瓣置换术的临床应用研究. 精准医学杂志, 2018, 33(2): 110-114.
7.	杨力凡, 潘文志, 赖浩, 等. 体外膜肺氧合支持下治疗重度主动脉瓣狭窄一例. 中华心血管病杂志, 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.	刘洋, 丁鹏, 程亮, 等. 体外膜肺氧合辅助经导管主动脉瓣植入治疗极低射血分数值的重度主动脉瓣狭窄. 中国体外循环杂志, 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.	Träger 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. 徐承义, 苏晞, 宋丹, 等. 体外膜肺氧合成功抢救碘帕醇对比剂致过敏性休克1例的体会. 内科急危重症杂志, 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. 中国医师协会心血管内科医师分会结构性心脏病专业委员, 中华医学会心血管病学分会结构性心脏病学组. 经导管主动脉瓣置换术中国专家共识. 中国介入心脏病学杂志, 2015, 23(12): 661-667.
4. 陈鹏飞, 胡信群, 方臻飞. 如何治疗主动脉瓣狭窄合并体外膜肺氧合支持下的心源性休克. 华西医学, 2018, 33(2): 223-229.
5. 陆莲, 方滨. 体外膜肺氧合成功治疗主动脉瓣置换术后低心排出量综合征1例报道. 现代医药卫生, 2015, 31(16): 2566-2568.
6. 金屏, 刘洋, 唐嘉佑, 等. 体外膜肺氧合辅助下经导管主动脉瓣置换术的临床应用研究. 精准医学杂志, 2018, 33(2): 110-114.
7. 杨力凡, 潘文志, 赖浩, 等. 体外膜肺氧合支持下治疗重度主动脉瓣狭窄一例. 中华心血管病杂志, 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. 刘洋, 丁鹏, 程亮, 等. 体外膜肺氧合辅助经导管主动脉瓣植入治疗极低射血分数值的重度主动脉瓣狭窄. 中国体外循环杂志, 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. Träger 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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