Percutaneous Valve Repair/Replacement

Abstract

Percutaneous valve replacement and repair have become a rapidly emerging treatment modality in the field of cardiology and cardiothoracic surgery due to the less invasive nature and the ability to prolong the lives of patients with significant comorbidities. When percutaneous techniques were introduced, most patients were treated under general anesthesia. However, studies and experience demonstrated over time that moderate sedation led to improved outcomes in the majority of patients. Methods to repair the valve include balloon valvuloplasty, edge-to-edge repair, annuloplasty, or complete valve replacement. Physical approaches can be performed via transfemoral, subclavian, axillary, radial, transcarotid, or, less commonly, transapical routes. Hemodynamic goals vary according to the type of valvular lesion being repaired, but the anesthesiologist should strive to maintain sinus rhythm, preload and afterload, and contractility of the heart through inotropic support.