Perioperative Management of Transcatheter Aortic Valve Replacement: Current Advancements and Controversies

Kratzert, Wolf B.; Mladenow, A; Boyd, Eva K.; Patel, Komal

doi:10.1007/s40140-015-0134-5

Cited by 1 publication

(1 citation statement)

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“…The new prosthetic valve is manipulated into position using X-ray machine and deployed over the existing aortic valve [18]. The goal of hemodynamic management during the procedure is to achieve hemodynamic stability with stringent blood pressure control [19]. There is an application of rapid ventricular pacing (RVP) during the dilatation and positioning of the aortic valve prosthesis to ensure that the systolic blood pressure is kept low [20].…”

Section: Transcatheter Aortic Valve Implantationmentioning

confidence: 99%

Spectral Entropy Parameters during Rapid Ventricular Pacing for Transcatheter Aortic Valve Implantation

Musialowicz

Valtola

Hippeläinen

et al. 2017

Entropy

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Abstract:The time-frequency balanced spectral entropy of the EEG is a monitoring technique measuring the level of hypnosis during general anesthesia. Two components of spectral entropy are calculated: state entropy (SE) and response entropy (RE). Transcatheter aortic valve implantation (TAVI) is a less invasive treatment for patients suffering from symptomatic aortic stenosis with contraindications for open heart surgery. The goal of hemodynamic management during the procedure is to achieve hemodynamic stability with exact blood pressure control and use of rapid ventricular pacing (RVP) that result in severe hypotension. The objective of this study was to examine how the spectral entropy values respond to RVP and other critical events during the TAVI procedure. Twenty one patients undergoing general anesthesia for TAVI were evaluated. The RVP was used twice during the procedure at a rate of 185 ± 9/min with durations of 16 ± 4 s (range 8-22 s) and 24 ± 6 s (range 18-39 s). The systolic blood pressure during RVP was under 50 ± 5 mmHg. Spectral entropy values SE were significantly declined during the RVP procedure, from 28 ± 13 to 23 ± 13 (p < 0.003) and from 29 ± 12 to 24 ± 10 (p < 0.001). The corresponding values for RE were 29 ± 13 vs. 24 ± 13 (p < 0.006) and 30 ± 12 vs. 25 ± 10 (p < 0.001). Both SE and RE values returned to the pre-RVP values after 1 min. Ultra-short hypotension during RVP changed the spectral entropy parameters, however these indices reverted rapidly to the same value before application of RVP.

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Section: Transcatheter Aortic Valve Implantationmentioning

confidence: 99%