Percutaneous aortic valve implants under sedation: our initial experience.
OBJECTIVE
We have developed an approach where percutaneous aortic valve (PAVI) procedures are done under remifentanil-based sedation administered by an anesthetist. We report here our initial experience.


BACKGROUND
Percutaneous aortic valve implantation is proving to be an effective treatment for aortic stenosis in patients with significant comorbidity precluding surgical aortic valve replacement. Most PAVIs have been done under general anesthetic with transoesophageal echocardiography (TOE). General anesthesia in this patient group is hazardous and associated with significant complications.


RESULTS
CoreValve implantation was performed via the retrograde approach in 12 patients at our cardiothoracic center between December 2007 and May 2008. Three had the procedure under general anesthetic and nine under sedation. There were no differences between the groups in terms of comorbidities and clinical characteristics. The procedure was visualized using fluoroscopic aortic calcification coupled with multiple small volume aortograms. One patient converted from sedation to general anesthetic during the procedure. One patient in the general anesthetic group died from respiratory complications. There were no significant differences in procedural success, procedure time, or hospital stay between the two groups.


CONCLUSIONS
Percutaneous aortic valve implantation can, in the majority of cases, be performed under remifentanil-based sedation. Our initial experience suggests that this should result in a shorter implant procedure time, reduced stay in high dependency areas, and shorter time to hospital discharge.
Behan
Miles
M
Sussex Cardiac Centre, Brighton and Sussex University Hospital NHS Trust, Eastern Road, Brighton UK, BN2 5BE.
Haworth
Peter
P
Hutchinson
Nevil
N
Trivedi
Uday
U
Laborde
Jean-Claude
JC
Hildick-Smith
David
D
D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000601:surgery*; D002404:Catheterization; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D010880:Piperidines / Q000009:adverse effects / Q000627:therapeutic use*; D011474:Prosthesis Design; D000077208:Remifentanil; D013997:Time Factors; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil