Anesthetic management of transcatheter aortic valve implantation

Covello, Remo Daniel; Landoni, Giovanni; Zangrillo, Alberto

doi:10.1097/aco.0b013e328347f99f

Cited by 26 publications

(24 citation statements)

References 60 publications

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“…On the other hand, local anaesthesia is associated with simple neurologic monitoring, short procedural time, improved patient satisfaction and reduced morbidity. 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.…”

Section: Discussionsupporting

confidence: 52%

“…Similar to their procedures, blood pressure was increased before starting the RVP in this study. However, the number and duration of RVP episodes should be minimized during the procedure to avoid the myocardial ischemia [3,4]. In this study, duration of the RVP was limited to less than 10 seconds and valve deployment was completed before the electrical cardioversion in case of a ventricular fibrillation due to ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…TAVI is a less invasive method compared to SAVR for patients with aortic stenosis. Especially, elderly patients with aortic stenosis have high mortality (4%-18%) during SAVR due to the increased medical comorbidities such as severe left ventricular dysfunction, renal and respiratory disease [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…The purpose of a good anaesthetic management during TAVI is to achieve the optimal hemodynamic stability maintaining the preload, afterload and contractility [5]. General anaesthesia or local anaesthesia plus sedation may be used according to patient's characteristics, the presence of additional diseases and the preference of the surgical team [4].…”

Section: Introductionmentioning

confidence: 99%

“…Scoring is done by evaluating multiple variables such as age, sex, preoperative state of the patient, serum creatinine levels, the presence of previous cardiac surgery and the presence of comorbid disease (active endocarditis, pulmonary, renal or peripheral vascular disease) [4].…”

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: 52%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

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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Transfemoral transcatheter aortic valve replacement

Mylotte

Martucci

Lange

et al. 2013

Endovascular and Hybrid Therapies for Structural Heart and Aortic Disease

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A retrospective study of conscious sedation versus general anaesthesia in patients scheduled for transfemoral aortic valve implantation: A single center experience

Renner

Tesdorpf

Freitag‐Wolf

et al. 2018

Health Science Reports

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ObjectivesThe current 2017 ESC/EACTS guidelines recommend transcatheter aortic valve implantations (TAVIs) as the therapy of choice for inoperable patients with severe symptomatic aortic stenosis. Most of the TAVIs worldwide are performed under general anaesthesia (GA). Although conscious sedation (CS) concepts are increasingly applied in Europe, it is still a matter of debate which concept is associated with highest amount of safety for this high‐risk patient population. The aim of this single center, before‐and‐after study was to investigate feasibility and safety of CS compared with GA with respect to peri‐procedural complications and 30‐day mortality in patients scheduled for transfemoral TAVI (TF‐TAVI).MethodsFrom March 2012 until September 2014, patients scheduled for the TF‐TAVI procedure were included in a prospective, observational manner. From the 200 patients finally included, 107 procedures were performed under GA, using either an endotracheal tube or a laryngeal mask, and balanced anaesthesia. CS was performed in 93 patients using low‐dose propofol and remifentanil.ResultsConversion to GA was needed 4 times due to procedural‐related complications (4.3%), in one patient due to ongoing agitation (1.1%). The CS‐group showed significantly shorter key time courses: anaesthesia time (105 [95‐120] minutes vs 115 [105‐140] minutes, P‐value = 0.009, Mann‐Whitney‐U‐test) and length of stay in the intensive care unit (1.6 [1.0‐1.5] d vs 2.1 [1.0‐2.0] d, P‐value = 0.002, Mann‐Whitney‐U‐test). The lowest mean arterial pressure was significantly higher in the CS‐group compared with the GA‐group (74.3 mmHg vs 55.2 mmHg, P‐value <0.0001, t‐test). CS was associated with less requirements of norepinephrine (0.1 μg/kg vs 2.3 μg/kg, P‐value <0.0001, Mann‐Whitney‐U‐test).ConclusionsOur single‐center data demonstrate that CS is a feasible and safe alternative, especially with respect to a higher degree of intra‐procedural haemodynamic stability, and a reduced length of stay in the intensive care unit.

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Anesthetic management of transcatheter aortic valve implantation

Cited by 26 publications

References 60 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

Transfemoral transcatheter aortic valve replacement

A retrospective study of conscious sedation versus general anaesthesia in patients scheduled for transfemoral aortic valve implantation: A single center experience

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