title: Anesthetic management of percutaneous aortic valve implantation: focus on challenges encountered and proposed solutions.
abstract: OBJECTIVE
  To describe 6 months of experience in the anesthetic management of percutaneous aortic valve implantation.
  
  
  METHODS
  An observational, cohort study.
  
  
  METHODS
  A university hospital.
  
  
  METHODS
  Eighteen high-risk patients with relative contraindications to surgical valve replacement (78 +/- 8.7 years, logistic EuroSCORE 26 +/- 19.1).
  
  
  METHODS
  An Edwards/Sapien Aortic Bioprosthesis (Edwards Lifesciences LLC, Irvine, CA) was implanted in patients with severe symptomatic aortic stenosis who underwent percutaneous retrograde aortic valve implantation without cardiopulmonary bypass. The procedure was performed using general anesthesia (15 patients) or sedation (3 patients).
  
  
  RESULTS
  The valve was successfully implanted in all patients. One patient had prolonged ventricular fibrillation that required advanced cardiopulmonary resuscitation, endotracheal intubation, and placement of an intra-aortic balloon pump. Six patients had vascular access site complications managed either percutaneously or surgically. Five patients were extubated in the catheterization laboratory. All patients were transferred to the intensive care unit for monitoring, and all but one were discharged to an intermediate care unit within 24 hours. Early postoperative complications included acute renal failure (1 patient), arrhythmias (1 atrial fibrillation and 1 transient heart block), and stroke (1 patient). One patient died 58 days after the procedure for noncardiac reasons.
  
  
  CONCLUSIONS
  Transcatheter aortic valve implantation is possible in selected high-risk patients. Anesthesiologists must be aware of current technology in order to have an active role in patient selection, to develop monitoring and standards of care in the cardiac catheterization laboratory, and to plan postoperative management.
authors.affiliation: Department of Cardiothoracic Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Remo Daniel
authors.initials: RD
authors.lastname: Covello
authors.forename: Giulia
authors.initials: G
authors.lastname: Maj
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Iassen
authors.initials: I
authors.lastname: Michev
authors.forename: Fabio
authors.initials: F
authors.lastname: Guarracino
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000777:Anesthetics / Q000008:administration & dosage*; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation* / Q000379:methods*; D000818:Animals; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D002404:Catheterization / Q000295:instrumentation / Q000379:methods; D002417:Cattle; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography
chemical_list: D000777:Anesthetics