Anesthetic management of percutaneous aortic valve implantation: focus on challenges encountered and proposed solutions.
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.
Covello
Remo Daniel
RD
Department of Cardiothoracic Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milan, Italy.
Maj
Giulia
G
Landoni
Giovanni
G
Maisano
Francesco
F
Michev
Iassen
I
Guarracino
Fabio
F
Alfieri
Ottavio
O
Colombo
Antonio
A
Zangrillo
Alberto
A
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
D000777:Anesthetics