htmlOn June 24, our hospital successfully performed the first TAVR surgery through the left axillary artery with ECMO support in Henan Province for an 85-year-old patient.
This operation is suitable for patients who have had multiple cardiac surgeries in the past, have recurrent heart failure after acute non-ST segment elevation myocardial infarction (NSTAMI), have renal insufficiency, stenosis of arteries in both lower extremities, and other underlying diseases. For the patient, Mr. Chen, this was a risky choice and another major test for the cardiology team of Zhengzhou No. 7 Hospital. The successful completion of the operation marks that our hospital has achieved a new breakthrough in the treatment of extremely high-risk complex structural heart disease and has moved to a higher level.
The patient, Mr. Chen, is 85 years old this year. He has a history of coronary stent implantation, atrial fibrillation one-stop, recurrent acute attacks on the basis of chronic heart failure, repeated difficult-to-correct pleural effusion, carotid artery stenosis, and lower limb arteries. He has a history of stenosis, hypertension, , chronic bronchitis, gastrointestinal bleeding, etc., and has many underlying diseases; but the patient is full of confidence and expectations for treatment. Although he is in his twenties, he has sharp ears and eyes, quick thinking, and a high degree of cooperation; his family members I also have great trust in doctors and hope that patients can have a better quality of life with the help of advanced medical technology.
After completing relevant preoperative examinations, it was found that Mr. Chen's heart was large, with a left ventricle of 64mm, a heart ejection fraction of 32%, and poor cardiac function. Bilateral carotid artery stenosis was severe, and rapid pacing during TAVR would cause In a state of transient hypotension, the risk of stroke is higher; at the same time, left main artery disease has a higher risk of acute coronary occlusion during surgery; in addition, the right subclavian artery and bilateral iliac artery severe stenosis, there is a need for surgery Access is difficult.
In view of these high-risk factors, after thorough evaluation and preparation by the multidisciplinary consultation (MDT) team of the Seventh Hospital, a series of measures were taken to actively correct the patient's heart failure before surgery, and coronary intervention was performed to correct the previous in-stent re-intubation of the left main coronary artery. Stenosis, carotid artery stent placement was performed to relieve the severe stenosis on the right side, nutritional support was given to improve hypoalbuminemia, preventive bedside hemofiltration corrected severe preoperative hyperuricemia, and the creatinine level was reduced, etc. After repeated discussions by the team, it was decided to perform TAVR surgery on the patient with ECMO support through the left axillary artery.
The operation started at 9:30 a.m. Vice President Zhao Yujie led Director Zhang Shenwei, Director Niu Siquan and other expert team members to perform the operation on Mr. Chen. With the assistance of ECMO, the intracardiac, extracardiac, anesthesia, and ultrasound teams worked closely together to perform anesthesia, puncture , transvalve, balloon expansion, precise positioning, and valve release... After more than two hours, the operation was successfully completed.
After the operation, through the active efforts of the CCU and the cardiac rehabilitation team, the patient recovered smoothly. At present, the patient's appetite has significantly improved, he no longer has recurrent pleural effusion, he can sleep on his back, walk on his own, and his life has returned to normal again. High-level TAVR surgery has allowed the octogenarian Mr. Chen to regain his "heart" life.
In recent years, TAVR has become the first-line treatment option for elderly patients with aortic valve stenosis, providing a new option for elderly patients who have previously lost the chance of surgery. It is sent into the interventional catheter through the femoral artery , and the artificial heart valve is delivered to the aortic valve area to open, thereby completing the artificial valve placement and restoring valve function. The surgery does not require a thoracotomy, so it is less invasive and allows for faster postoperative recovery.
The successful completion of this high-risk and complex TAVR operation is not only a new breakthrough in the treatment of cardiac structural lesions in our hospital, but will also bring new hope and ideas for the treatment of more elderly and critically ill patients.
