Fast-track anesthesia in lateral mini-thoracotomy for transapical transcatheter valve implantation

Abstract

Patients who undergo transapical transcatheter aortic/mitral valve implantation are at higher risk of morbidity and mortality than those undergoing transvascular procedures. In addition, these patients have prolonged intensive care and hospital courses. Fast-track anesthesia could reduce perioperative complications and admission stays in such patients. Methods:This retrospective single-center study, evaluates six high-risk patients undergoing transapical valve implantation between 01/2020 till 01/2021. All patients received a paravertebral block (PVB) as part of a fast-track approach. The airway was secured with a Gastro-double-lumen laryngeal mask which includes one orifice was for ventilation and one for the transesophageal echocardiography probe. Anesthesia was maintained with a volatile anesthetic (Sevoflurane MAC 1%). Immediately post procedure, all patients were awakened and admitted to the intermediate/intensive-care unit.Results: Three patients were females, mean age =71±6 years, patients' risk profiles were high (mean Log. EuroSCORE-I 22% & STS-PROM 10%). No incidents of re-intubation, atelectasis/pneumonia, low output syndrome, stroke, dialysis, pacemaker implantation or operative mortality were reported. One patient (16.7%) underwent re-exploration for bleeding and developed a wound infection. Postoperative pain scores showed that no patient required additional analgesics after the initial eight hours post procedure. Mean postoperative intermediate/intensive-care stay was 13.8±3.2 hours and patients were mobilized early and discharged to the normal ward. Conclusions:Fast-track anesthesia using paravertebral-blockade for transcatheter transapical valve replacement in high-risk patients is a possible anesthetic approach. An effective PVB, in addition to a doublelumen laryngeal mask, provide an alternative strategy to conventional general anesthesia. These promising results could encourage further consideration of this approach in similar cardiac surgery patients.

Anesthetic Management during Robotic-Assisted Minimal Invasive Thymectomy Using the Da Vinci System: A Single Center Experience

“…The use of analgesics decreased during ICU or IMC stay within the subsequent hours and almost diminished after twenty-four hours. The induction of regional anesthesia minimizes intra- and postoperative opioid consumption [ 15 ] which is of utmost importance in high-risk patients undergoing thoracic surgery [ 16 ]. This has also been observed in our analysis, the additional administration of a long-acting regional anesthetic agent using bupivacaine allowed the reduction of opioid usage during surgery and after admission to the ICU or IMC.…”

Impact of Non-Valvular Non-Coronary Concomitant Procedures on Outcomes of Surgical Aortic Valve Replacement in Intermediate Risk Patients

“…In Germany, the number of TAVI procedures increased from 2198 in 2009 to 13,279 in 2018, which represents 57.5% of the isolated aortic valve procedures [ 1 ]. Different strategies, implantation modifications and different outcomes and complications have been widely discussed for the TAVI procedures [ 6 , 7 , 8 ]. However, combined non-valvular and non-coronary pathologies, including ascending aorta aneurysm, septum hypertrophy, small annuli, atrial fibrillation (AF) and patent foramen ovale (PFO), are factors leading to SAVR procedure.…”