Outcome of patients undergoing TAVR with and without the attendance of an anesthesiologist

Konigstein, Maayan; Ben-Shoshan, Jeremy; Zahler, David; Flint, Nir; Margolis, Gilad; Granot, Yoav; Aviram, Galit; Halkin, Amir; Keren, Gad; Banai, Shmuel; Finkelstein, Ariel

doi:10.1016/j.ijcard.2017.01.154

Cited by 26 publications

(14 citation statements)

References 16 publications

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“…Trans-subclavian or trans-carotid TAVR has been performed under LA/CS in only limited cohorts. 20,23 Many studies have confirmed similar 30-day mortality rates between LA/CS and general anesthesia, 3,4,20,24 with even better 30-day outcome of LA/CS shown by recent large meta-analysis (mortality, relative risk − RR: 0.73; 95%CI 0.57-0.93; p=0.01), 5 including 26 studies and 10,572 patients. Another meta-analysis published in the same year, with 19 studies, showed no differences between the two anesthetic techniques (RR: 0.91; 95%CI 0.70-1.18; p=0.48).…”

Section: Local Anesthesia/conscious Sedationmentioning

confidence: 93%

Minimalist approach for transcatheter aortic valve replacement

Dallan¹,

Ichibori²,

Attizzani³

2019

J Transcat Intervent

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Transcatheter aortic valve replacement became a routine interventional procedure worldwide, together with improvements in valve technology and optimized implant techniques. The concept of minimalist approach became relevant, aiming at optimal technical implant, fewer perioperative comorbidities, and consequently faster recovery and less associated risks. Compared with surgical aortic valve replacement, reduction of hospital and intensive care unit stay and fewer rates of procedural complications offset the high costs of transcatheter aortic valve replacement valves. The principles of the minimalist approach consist on top performance by experienced structural interventionists, a complete transcatheter basis under local anesthesia and conscious sedation, together with bedside transthoracic echocardiography to access hemodynamic features. It is necessary to customize transcatheter aortic valve replacement optimal procedure by revising how to simplify each aspect of the patient's care process, without losing focus on safety and best outcomes based on individualized patient characteristics, center's expertise, and multidisciplinary care. This review aimed to summarize the current evidence for a minimalist approach to transfemoral transcatheter aortic valve replacement and provide information for its safe and successful implementation and customization.Keywords: Transcatheter aortic valve replacement; Aortic valve/surgery; Aortic valve stenosis; Heart valve prosthesis implantation/methods resumo -O implante transcateter de válvula aórtica tornou-se uma intervenção de rotina em todo o mundo, acompanhando as melhorias na tecnologia das válvulas e a otimização das técnicas de implante. O conceito de abordagem minimalista tornou-se relevante, visando obter um implante tecnicamente ideal, menos comorbidades perioperatórias e, consequentemente, recuperação mais rápida e com menos riscos associados. Em comparação à cirurgia de troca da válvula aórtica, a redução no tempo de hospitalização e na unidade de terapia intensiva, e a menor incidência de complicações do procedimento acabam por compensar os custos mais altos das válvulas para o implante transcateter de válvula aórtica. Os princípios da abordagem minimalista consistem em desempenho superior de intervencionistas estruturais experientes, uma base estrutural completa sob anestesia local e sedação consciente, juntamente da ecocardiografia transtorácica à beira do leito, para avaliar características hemodinâmicas. É necessário customizar um procedimento ideal do implante transcateter de válvula aórtica, procurando simplificar cada um dos aspectos da atenção ao paciente, sem perder o foco na segurança e na obtenção dos melhores desfechos, com base nas características individuais na experiência do centro e no atendimento multidisciplinar. Esta revisão teve como objetivo sintetizar as evidências atuais para uma abordagem minimalista do implante transcateter de válvula aórtica transfemoral, e fornecer informações para garantir a segurança e o sucesso da implementação e customi...

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Section: Local Anesthesia/conscious Sedationmentioning

confidence: 93%

Minimalist approach for transcatheter aortic valve replacement

Dallan¹,

Ichibori²,

Attizzani³

2019

J Transcat Intervent

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“…Anesthesiologists participate in most TAVR cases. 4 Cardiac anesthesiologists are involved in the preprocedural workup of patients as part of the heart team approach to TAVR, as recommended by the ACC. 5 They care for these patients during the procedure in the operating room or catheterization laboratory and after the procedure in recovery rooms and intensive care units.…”

Section: Why Is This Important To the Cardiac Anesthesiologist?mentioning

confidence: 99%

Anesthetic Management of Conduction Disturbances Following Transcatheter Aortic Valve Replacement: A Review of the 2020 ACC Expert Consensus Decision Pathway

Neuburger

Pospishil

Ibrahim

2021

Journal of Cardiothoracic and Vascular Anesthesia

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“…Anesthesia for TAVR procedures was initially performed with general anesthesia, but this is becoming increasingly less common in favor of conscious sedation [1,44]. In fact, available data fail to show a difference in outcomes between those patients who undergo TAVR with general anesthesia versus those who have conscious sedation, or even whether or not an anesthesiologist is physically present for the procedure [44][45][46]. TAVR procedures performed with conscious sedation have been shown to result in decreased morbidity at 30 days, shorter intensive care unit stays, and decreased overall length of stay compared with general anesthesia [44].…”

Section: Emerging Evidencementioning

confidence: 99%

Update on Transcatheter Aortic Valve Replacement

Randall

Bavry

2020

Cardiol Ther

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Transcatheter aortic valve replacement (TAVR) is a minimally invasive approach to treat symptomatic severe aortic stenosis. The patient populations that have been shown to benefit from this procedure continue to grow with time. Techniques and technology in TAVR persistently advance with a continued trend toward improved outcomes for patients. In this review, we highlight the advances in vascular access, TAVR valve design, progress in reducing procedural complications, and emerging evidence in the field.

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Outcome of patients undergoing TAVR with and without the attendance of an anesthesiologist

Cited by 26 publications

References 16 publications

Minimalist approach for transcatheter aortic valve replacement

Minimalist approach for transcatheter aortic valve replacement

Anesthetic Management of Conduction Disturbances Following Transcatheter Aortic Valve Replacement: A Review of the 2020 ACC Expert Consensus Decision Pathway

Update on Transcatheter Aortic Valve Replacement

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