Anesthesia and Perioperative Management of Patients Undergoing Transcatheter Aortic Valve Implantation: Analysis of 90 Consecutive Patients With Focus on Perioperative Complications

Guinot, Pierre-Grégoire; Depoix, Jean‐Pol; Etchegoyen, L.; Benbara, Abdel; Provenchère, Sophie; Dilly, Marie-Pierre; Philip, Ivan; Enguerand, D.; Ibrahim, Hassan; Vahanian, Alec; Himbert, Dominique; Al-Attar, Nawaar; Nataf, Patrick; Desmonts, Jean-Marie; Montravers, Philippe; Longrois, Dan

doi:10.1053/j.jvca.2009.12.019

Cited by 74 publications

(57 citation statements)

References 39 publications

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“…But local anaesthesia had also some disadvantages such as patient discomfort due to local anaesthetic infiltration and catheters placement, patient's possible movements and increased risk for prosthesis misplacement [4]. Similar to our study, all approaches of TAVI were performed under general anaesthesia with fluoroscopic and TEE guidance in Guinot et al 's [6] study. However, Dehedin et al [12] analysed the data of the patients who underwent transfemoral TAVI with general or local/regional anaesthesia.…”

Section: Discussionsupporting

confidence: 70%

“…They also reported decreased mean NYHA (New York Heart Association) functional capacity after 3 months of the procedure compared with the previous values. In another study, Guinot et al [6] analysed 62 patients treated with TAVI via the transfemoral approach. They also reported high procedural success rate (90%).…”

Section: Discussionmentioning

confidence: 99%

“…Coordinated multidisciplinary approach (cardiologist, cardiothoracic surgeon, anaesthesiologist, perfusionist and assistant health personnel) is essential for the success of TAVI. Careful anaesthetic management during TAVI reduces the recovery time after the procedure and the risk of potential complications such as extreme hypotension and hemodynamic instability [5,6]. The purpose of a good anaesthetic management during TAVI is to achieve the optimal hemodynamic stability maintaining the preload, afterload and contractility [5].…”

Section: Introductionmentioning

confidence: 99%

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Transcatheter Aortic Valve Implantation: First Applications and Short Term Outcomes in Our Clinic

et al. 2015

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Objective: The objective of this study is to evaluate the first applications and short term outcomes of transcatheter aortic valve implantation (TAVI) in our clinic, which is a new technology for the patients with high risk for surgical aortic valve replacement (SAVR). Materials and Methods:Between January 2010 and December 2012, twenty five patients (16 males, 9 females; mean age 74.04±8.86 years) diagnosed with severe aortic stenosis, who were at high risk for surgery (EuroSCORE II: 5.58±4.20) and underwent TAVI in our clinic, were evaluated. The demographic and clinical characteristics of patients, anaesthetic management, complications during pre-and post-operative periods and the mortality rate in the first 30 days and six months were recorded.Results: Edwards SAPIEN Valve prostheses were implanted by transfemoral approach (percutaneously in 10 patients and surgically in 15 patients) in all patients. The TAVI procedure was performed under general anaesthesia. The success rate of the TAVI procedure was 100%. Three patients had limited dissection of the femoral artery; however, intervention was not needed due to good distal perfusion rate. Permanent pacemaker was implanted to four patients because of long-term atrioventricular blockage. After the procedure, all patients were transferred to the Intensive Care Unit (ICU) and all patients were extubated in the ICU. The mean mechanical ventilation duration (minutes) was 166.20±39.32, the mean critical care unit stay (day) was 5.64±2.99 and the mean hospital stay (day) was 11.92±5.54. Acute renal failure was observed in one patient and stroke was observed in two patients on the first postoperative day. The mortality rate in the first 30 days and 6 months was found to be 4% and 16%, respectively. Conclusion:Transcatheter aortic valve implantation is a great option for patients with severe aortic stenosis who are at high risk for SAVR. In our institute, procedural success and short term outcomes for patients underwent TAVI were found to be similar to the other studies in the national and international literature. Bulgular: Tüm hastalarda Edwards SAPIEN Valve protez transfemoral yaklaşımla (10 hastada perkutanöz, 15 hastada cerrahi yöntemle) yerleştirildi. Tüm hastalarda TAVI işlemi genel anestezi altında yapıldı ve transözefagial ekokardiyografi tüm hastalara uygulandı. TAVI işleminin başarı oranı %100 idi. İşlem süresince mortalite ve ciddi komplikasyon izlenmedi. Üç hastada femoral arterde sınırlı disseksiyon görüldü, ancak distal perfüzyonun iyi olması nedeniyle herhangi bir müdahale gerekmedi. Uzun süreli atriyoventriküler blokaj nedeniyle dört hastaya kalıcı pacemaker takıldı. İşlem sonrası, tüm hastalar Yoğun Bakım Ünitesi'ne (YBÜ) gönderildi ve tüm hastalar YBÜ'de ekstübe edildi. Ortalama mekanik ventilasyon süresi (dakika): 166,20±39,32, ortalama yoğun bakımda kalış süresi (gün): 5,64±2,99 ve ortalama hastanede kalış süresi (gün): 11,92 ±5,54 idi. Postoperatif birinci gün, bir hastada akut renal yetmezlik ve iki hastada inme izlendi. İlk 30 gündeki mo...

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transcatheter Aortic Valve Implantation: First Applications and Short Term Outcomes in Our Clinic

et al. 2015

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“…The institutional ethics committee approved the study and all patients gave signed written informed consent. Following evaluation of the individual patient on the basis of international recommendations by a cardiologist, cardiac surgeon, and anesthesiologist, a decision of suitability for not only the high risk of conventional surgery but also for TAVI was made (6)(7)(8)(9)(10)(11). Preoperatively, in addition to clinical evaluation, all patients were screened by transthoracic echocardiography, coronary angiography, iliofemoral contrast angiography, and computed tomography.…”

Section: Methodsmentioning

confidence: 99%

Anesthetic management and perioperative complications in transcatheter aortic valve implantation: the Turkish experience

Gümüş¹,

Kesimci²,

Soykut³

et al. 2014

Turk J Med Sci

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“…Traditionally, TAVI is performed under general anesthesia provided by a qualified anesthetist experienced in managing conventional cardiac surgery (Guinot et al, 2010). Growing experience, expansion of the indication to "intermediate-risk" patients, and economic considerations have led to an increasing interest and discussion about performing transfemoral TAVI under sedation (Mayr et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Bispectral index-guided sedation in transfemoral transcatheter aortic valve implantation: a retrospective control study

Huang

Shi

et al. 2017

J. Zhejiang Univ. Sci. B

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Abstract:Objective: Transcatheter aortic valve implantation (TAVI) is a minimally invasive therapy for elderly patients with severe aortic valve stenosis who were refused surgical aortic valve replacement because of the high perioperative risk. Traditionally, this procedure has been done under general anesthesia, but more recently local anesthesia and sedation have become popular. This research assessed the effectiveness of transfemoral TAVI under bispectral index (BIS)-guided sedation. Methods: In this single-center retrospective control analysis, clinical data, including demographic characteristics, echocardiography, periprocedural data, and main complications, were collected and assessed in 113 patients undergoing TAVI through the femoral artery under general anesthesia (GA group, n=36) and under BIS-guided sedation (SED group, n=77). Results: The demographic characteristics and echocardiographic parameters between the two groups were similar (P>0.05). Two (2.6%) of patients were moved from BIS-guided sedation to general anesthesia for surgical reasons. Procedures were significantly shorter in the SED group than in the GA group ((127.10±44.43) min vs. (165.90±71.62) min, P=0.004). Patients in the SED group lost less blood and received significantly fewer red blood cells and catecholamines than those in the GA group (5.19% vs. 22.22%, P=0.017 and 67.53% vs. 97.22%, P<0.001). The length of hospital stay was significantly shorter and there were fewer pulmonary complications in the SED group than in the GA group. Thirty-day mortality was similar between the two groups. Conclusions: BIS-guided sedation is a feasible and safe approach for transfemoral TAVI. The anesthesiologist should choose the best anesthetic method according to the team's experience.

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Anesthesia and Perioperative Management of Patients Undergoing Transcatheter Aortic Valve Implantation: Analysis of 90 Consecutive Patients With Focus on Perioperative Complications

Cited by 74 publications

References 39 publications

Transcatheter Aortic Valve Implantation: First Applications and Short Term Outcomes in Our Clinic

Transcatheter Aortic Valve Implantation: First Applications and Short Term Outcomes in Our Clinic

Anesthetic management and perioperative complications in transcatheter aortic valve implantation: the Turkish experience

Bispectral index-guided sedation in transfemoral transcatheter aortic valve implantation: a retrospective control study

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