Anesthetic Considerations for Transcatheter Pulmonary Valve Replacement

Noteworthy Literature published in 2017 for Congenital Cardiac Anesthesiologists

“…Two surgical PVR and 7 TCPVR patients developed IE with a 4-year freedom from IE of 94% in the surgical group versus 84% in the TCPVR group ( P = .13), which suggests that TCPVR is not at a higher risk of IE. The anesthetic considerations for TCPVR are nicely reviewed by Gregory et al 84 It is well established that adults with CHD are at increased risk of IE, but there are very few studies that look at the knowledge level of patients about IE and IE prophylaxis. Bauer and colleagues in Germany found important knowledge gaps, where 20% to 30% of adults with CHD and a strict recommendation for antibiotic prophylaxis did not possess knowledge of IE and misjudged their risk for IE.…”

Beyond the Third Dimension: Intracardiac Echocardiography—The Next Frontier for Cardiac Anesthesiologists

“…The use of ICE for procedural guidance has already been reported in percutaneous mitral interventions, paravalvular leak closures, mitral commissurotomies, transcatheter mitral valve replacements, transcatheter pulmonary valve replacements, transcatheter tricuspid valve repairs, and valve-in-valve implantations. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] ICE is also commonly used for patent foramen ovale and atrial septal defect closures, as it provides superior visualization of the atrial septum with increased patient comfort. 22,23 ICE will likely become a feasible alternative to TEE in many settings, and obviates the need for general anesthesia, endotracheal intubation, and the attendant risks.…”