Transcatheter Aortic Valve Replacement

Nontransfemoral Approaches to Transcatheter Aortic Valve Replacement

“…Compliant arteries can usually accommodate sheaths that are 1 to 2 mm larger than their internal diameters, although not in the case of severe atheromatous disease, calcification, or tortuosity. 20 If there are significant concerns with any of these factors (size, calcification, tortuosity), then alternative access is used. This is always a consensus decision among the dedicated heart valve team.…”

Intensive Care Unit Management of Transcatheter Aortic Valve Recipients

“…Transcranial Doppler studies have shown that most strokes occur during balloon aortic valvuloplasty, catheter manipulation across the stenotic valve, and valve manipulation. [15][16][17] Given the risk of neurological events, formal neurological evaluation should be performed in the perioperative period.…”

Catheter-based Cardiac Surgery

“…34 The SAPIEN is available in either a 23 or 26 mm size, with FDA approval pending for the 20 and 29 mm sizes. 34 The SAPIEN is available in either a 23 or 26 mm size, with FDA approval pending for the 20 and 29 mm sizes.…”

“…34 There is more published experience in the United States with the SAPIEN compared with the CoreValve, thus much of this discussion will reflect that experience. TA approaches utilize a 26 Fr delivery sheath.…”

“…30,31,35 In addition to the usual preoperative evaluation for AVR (i.e., symptomatic AV stenosis), TAVR patient selection includes the following criteria for most centers: adequately sized aortic annulus; elevated Society of Thoracic Surgeons risk score (typically more than 9 to 10%), denial of surgery by two surgeons, or both; advanced lung disease; functional coronary vessels/ grafts; degree of frailty; functional status; and the usual comorbidities of diabetes, renal disease, and coronary artery disease. 34,35 Pre-anesthetic evaluation should also focus on degree of lung disease to predict extubation after the procedure, airway anatomy, overall cardiac functional status, neurological status, and any history of previous anesthetic difficulties. 34,35 The next phase of diagnostics includes evaluation of the aortic annulus, typically via transthoracic echocardiography or TEE, in addition to computerized tomography and angiography.…”