Percutaneous Transarterial Aortic Valve Replacement in Selected High-Risk Patients With Aortic Stenosis

Webb, John G.; Pasupati, Sanjeevan; Humphries, Karin H.; Thompson, Christopher R.; Altwegg, Lukas; Moss, Robert; Sinhal, Ajay; Carere, Ronald G.; Munt, Brad; Ricci, Donald R.; Ye, Jian; Cheung, Anson; Lichtenstein, S.

doi:10.1161/circulationaha.107.698258

Cited by 939 publications

(705 citation statements)

References 31 publications

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“…[2][3][4][5] Transcatheter aorticvalve replacement (TAVR) has emerged as an alternative therapy in high-risk patients with aortic stenosis. [6][7][8][9][10] Observational registries from various countries have reported 1-month and 1-year outcomes after TAVR, [11][12][13][14] but there are limited long-term follow-up data. 15 The Placement of Aortic Transcatheter Valves (PARTNER) trial was a randomized trial comparing TAVR with standard-of-care therapies in highrisk patients with aortic stenosis.…”

Section: Resultsmentioning

confidence: 99%

Two-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement

Kodali¹,

Williams²,

Smith³

et al. 2013

Survey of Anesthesiology

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266

340

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Section: Resultsmentioning

confidence: 99%

Two-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement

Kodali¹,

Williams²,

Smith³

et al. 2013

Survey of Anesthesiology

Self Cite

266

340

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“…Besides the small number of patients, there is a sharp learning curve. The improvement of outcomes after the initial intervention is clear in the literature [23,24].…”

Section: Discussionmentioning

confidence: 97%

Implante transapical de valva aórtica: resultados de uma nova prótese brasileira

Gaia¹,

Palma²,

Ferreira³

et al. 2010

Rev Bras Cir Cardiovasc

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Objective: The aortic valve replacement is a routine procedure with acceptable risk, but in some cases, such a risk can justify contraindication. The minimally invasive transcatheter aortic valve implantation has been viable, with lower morbidity and mortality. The aim of this study was to develop a national catheter-mounted aortic bioprosthesis for the aortic position implant.Methods: After animal studies, 14 patients with high EuroSCORE underwent transcatheter aortic valve implantation. Median Logistic EuroSCORE was 43.7%. Four patients presented with dysfunctional bioprosthesis, remaining ones presented calcified aortic stenosis. All patients presented symptoms. Procedures were performed in a hybrid OR under fluoroscopic and echocardiography guidance. Using a left minithoracotomy the prosthesis was implanted through the ventricular apex under ventricular pacing or hemorrhagic shock, after aortic valvoplasty. Echocardiograph and angiograph controls were performed, and the patients were referred to ICU.Results: Implant was feasible in 13 cases. There were no intra-operative deaths. Rev Bras Cir Cardiovasc 2010; 25(3): 293-302 treatment. The survival rate with the technique was not satisfactory with a mortality rate of 65% at 1 year. Only 40% of patients at 1 year were free of reintervention, aortic valve replacement surgery, heart block, or death [6]. 294 GAIA, DF ET AL -Transapical aortic valve implantation: results of a Brazilian prosthesis

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“…We believe that the comprehensive perioperative involvement of anesthesiology as part of a multidisciplinary team has significantly contributed to the improved outcomes achieved after the first series of patients. 21 in summary, percutaneous replacement of the AV by a retrograde femoral approach is a new and exciting development in the treatment of aortic stenosis. Although it represents an intriguing alternative for those patients not considered candidates for conventional surgery, there are a number of significant concerns, as this case series demonstrates.…”

Section: Discussionmentioning

confidence: 99%

“…To an extent, these complications may be part of a learning curve that accompanies any novel technique such as this. 21 Future developments that may improve patient safety with this procedure include smaller profile catheters and sheaths that minimize trauma to the vascular access site, alternative methods of reducing left ventricular outflow during device placement that may be more cardioprotective, and the use of intracardiac echocardiography to possibly allow this procedure to be performed under local anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Case series: anesthesia for retrograde percutaneous aortic valve replacement — experience with the first 40 patients

Ree

Bowering

Schwarz

2008

Can J Anesth/J Can Anesth

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Purpose: To describe both the evolution and the main associated complications in the anesthetic management of the initial 40 patients at our centre who underwent percutaneous retrograde aortic valve replacement, a novel technique utilizing a catheterguided femoral artery approach. Clinical features:With institutional Research Ethics Board approval, we retrospectively reviewed the medical records of the first 40 patients who underwent percutaneous retrograde aortic valve replacement between January 2005 and March 2006. Information obtained included patient characteristics, anesthetic management, details of the procedure, and complications. All procedures were scheduled to be performed in the cardiac catheterization laboratory. The first four patients received monitored anesthesia care, and the subsequent 36 underwent general anesthesia. There were no anesthesia-related adverse events. The prosthetic valve was placed successfully in 33/40 patients (83%). Median anesthetic time was 3.5 hr (range, 1.25-7.25 hr). Thirty-two/40 patients required vasopressor support. The most common, serious procedural complications were myocardial ischemia and arrhythmia following rapid ventricular pacing, hemorrhage from vascular injury secondary to the placement and removal of the large-bore sheath in the ilio-femoral artery, aortic rupture, and prosthetic valve maldeployment; 30-day mortality was 13% (n = 5/40). Conclusions:Percutaneous retrograde aortic valve replacement is a novel procedure that presents the anesthesiologist with unique challenges. Careful preoperative assessment, intraoperative monitoring appropriate for a major vascular procedure, and meticulous management of hemodynamics are imperative for a successful outcome. Serious complications, including major hemorrhage from vascular injury as well as arrhythmia and myocardial ischemia following rapid ventricular pacing, must be anticipated and managed in an expeditious fashion.

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Percutaneous Transarterial Aortic Valve Replacement in Selected High-Risk Patients With Aortic Stenosis

Abstract: Percutaneous valve replacement may be an alternative to conventional open heart surgery in selected high-risk patients with severe symptomatic aortic stenosis.

Cited by 939 publications

References 31 publications

Two-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement

Two-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement

Implante transapical de valva aórtica: resultados de uma nova prótese brasileira

Case series: anesthesia for retrograde percutaneous aortic valve replacement — experience with the first 40 patients

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