Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Transcatheter aortic valve implantation: anesthetic management and considerations Bianco, Juan Carlos, Guardabassi Diego, Battellini Roberto R, Falconi Mariano, Agatiello Carla R., Berrocal Daniel H. Introduction: Aortic stenosis (AS) is the most common form of adult valvular heart disease.1 Many patients with severe AS and multiple comorbidity conditions are not candidate for surgical replacement of the aortic valve, which is currently the goldstandard treatment. Transcatheter aortic-valve implantation (TAVI) has been suggested as a less invasive treatment for high-risk patients with AS. Objective: The aim of this study is to report the anesthetic considerations and management in the first nineteen TAVI with the CoreValve Revalving™ system. Methods: Patients with severe AS who had been refused surgery because of comorbidity were enrolled. Nineteen high-risk surgical patients underwent TAVI between march 2009 and august 2011, under general anesthesia. The induction and maintenance of anesthesia was done avoiding bradycardia or tachycardia, maintaining systemic vascular resistant and preserving preload. A general anesthetic was tailored to achieve extubation after procedure completion, whereas IV access and pharmacological support allowed for sudden hemodynamic changes, emergent sternotomy and initiation of cardiopulmonary bypass. Aortic balloon valvuloplasty was performed first under rapid ventricular pacing and then retrograde CoreValve was implanted. Transesophageal echocardiography (TEE) was performed to confirm the diagnosis, determine ventricular function, annulus size, aortic pathology, and mitral regurgitation. It evaluated the Corevalve function, measured aortic regurgitation and assessed for aortic dissection, pericardial effusion and myocardial ischemia. Result: Patients were 79 ± 7 years (63%male), with multiple comorbidities (EuroSCORE = 22,16 ± 9,74%). Patients who survived to the procedure (94,7%) were extubated and transfer to intensive care unit without vasoactive or inotropic infusions. The most common in-hospital complications were third degree atrioventricular block (42,11%) and need for permanent pacemaker (26,32%). One patient underwent aortic valve replacement after TAVI because of symptomatic severe perivalvular leak. No patient required intraoperative transfusions. After a mean follow up of 317+-263 days, the rate of survival was 89,47%. Early hospital discharge was not always possible because of the comorbilities, been an average of 8,1 ± 6,9 days. Conclusion: Corevalve TAVI procedure in high risk patients appeared feasible and safe. Anesthesiologists have to manage critical patients with severe cardiac and noncardiac comorbilities applying the expertise to a novel procedure. References 1. Eur Heart J. 2003;24(13):1231-43