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Purpose of the guideline：
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Although TAVI can be used as the first non-invasive alternative treatment for weak and high-risk aortic stenosis, its operation is complex, and many surgical related complications may occur during the perioperative period, such as cerebral infarction, coronary artery occlusion, acute renal failure and conduction obstruction hemodynamic disorder. The patient's weak physical condition and new complications may further worsen the condition and greatly reduce the survival rate. We urgently need a new method to provide auxiliary support treatment for high-risk TAVI patients in the perioperative period, improve the prognosis and improve the survival rate of patients. Extracorporeal membrane oxygenation (ECMO) is an important extracorporeal life support technology. It can correct hemodynamic disorders, improve tissue perfusion, and strive for treatment time for patients by completely replacing or partially replacing cardiopulmonary function for circulatory support. ECMO is mainly used for supporting treatment of patients with heart failure and/or pulmonary failure clinically, and has been applied to varying degrees in patients with cardiogenic shock and high-risk percutaneous coronary intervention. With the popularization of ECMO, since 2020, centers at home and abroad have tried to apply ECMO to high-risk TAVI patients during perioperative period, and achieved good results. Venous artery (V-A) ECMO is especially suitable for emergency cases related to life threatening TAVI, such as cardiac tamponade, severe valve regurgitation, cardiogenic shock, aortic annulus rupture, ventricular arrhythmia, coronary artery occlusion, valve prosthesis displacement and sustained myocardial contractility impairment. The prophylactic use of V-A ECMO is also used in high-risk TAVI cases, which can maintain the stability of hemodynamics and reduce the burden on the heart, and greatly improve the prognosis of patients. ECMO plays an important role in both the preoperative supportive treatment of TAVI and the occurrence of respiratory and cardiac arrest during operation. However, at present, the perioperative treatment of high-risk TAVI patients supported by ECMO is only in the trial stage, only a few cases are reported, the technical points are not clear, and no systematic expert consensus has been formed. For this reason, Qilu Hospital of Shandong University took the lead to jointly formulate the Expert Consensus on Perioperative Technical Essentials of ECMO Assisting High Risk TAVI, aiming to summarize and standardize the application of ECMO during high-risk TAVI, and provide guidance for further clinical practice and related research, so as to improve the survival rate of TAVI patients supported by ECMO in China, improve the prognosis of patients and improve the quality of life. |
