Anesthesia management for transapical transcatheter aortic valve implantation: a case series.
OBJECTIVE
The purpose of this study was to review the management of anesthesia for transapical transcatheter aortic valve implantation.


METHODS
Retrospective review of collected data.


METHODS
University-affiliated heart center.


METHODS
One hundred consecutive patients with severe aortic stenosis.


METHODS
General anesthesia followed by an established fast-track protocol.


METHODS
A total of 100 patients with significant AS received transapical transcatheter aortic valve implantation. The patients were treated following a fast-track protocol. The mean arterial pressure was maintained above 65 mmHg by volume and/or inotropes during the procedure. The mean arterial pressure was increased above 75 mmHg to avoid hemodynamic deterioration before starting rapid ventricular pacing for the balloon valvuloplasty and the valve implantation. Transesophageal echocardiography was used to assess valve size and for hemodynamic monitoring. Eighty-one patients were treated completely off pump. There was a significant decline in mean arterial pressure from pre- to postvalvuloplasty (74.7 +/- 9.1 mmHg v 63.6 +/- 11.3 mmHg, p < 0.001) and from pre- to postimplantation (76.5 +/- 12.6 mmHg v 67.2 +/- 12.7, p < 0.001). The first 10 patients in the study intentionally were placed on cardiopulmonary bypass, and 9 patients required cardiopulmonary bypass because of hemodynamic deterioration.


CONCLUSIONS
A well-designed anesthetic plan as well as an understanding of the surgical procedure and the hemodynamic effects of rapid ventricular pacing are required to ensure successful outcomes in this new surgical option for high-risk patients.
Fassl
Jens
J
Department of Anesthesiology and Intensive Care II, University of Leipzig, Heart Center, Leipzig, Germany.
Walther
Thomas
T
Groesdonk
Heinrich Volker
HV
Kempfert
Joerg
J
Borger
Michael Andrew
MA
Scholz
Markus
M
Mukherjee
Chirojit
C
Linke
Axel
A
Schuler
Gerhard
G
Mohr
Friedrich Wilhelm
FW
Ender
Joerg
J
D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000379:methods*; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D002404:Catheterization / Q000379:methods*; D019468:Disease Management; D004562:Electrocardiography / Q000379:methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors