Transcatheter implantation of an aortic valve: anesthesiological management.
OBJECTIVE
Transcatheter aortic valve implantation (TAVI) is an emergent alternative technique to surgery in high-risk patients with aortic stenosis. Here, we describe the anesthesiological management of patients undergoing TAVI at our institution over an 18-month period.


METHODS
After a proper assessment of surgical risk and comorbidities, 69 patients underwent TAVI with the transfemoral/subclavian approach. Both Edwards-Sapien and Corevalve prostheses were implanted. The anesthetic regimen consisted of general anesthesia or local anesthesia plus sedation.


RESULTS
Twenty-seven patients received general anesthesia, and 42 received local anesthesia plus sedation. Procedural complications included prosthesis embolization (2), ascending aorta dissection (1), ventricular fibrillation following rapid ventricular pacing (8), vascular access site complications (17), and the valve-in-valve procedure (1). Three patients had to be converted from local anesthesia to general anesthesia (one patient had refractory ventricular fibrillation, and two patients were restless). All patients were alive at the 30-day follow-up. Mechanical ventilation time was 8.5+/-0.03 h. Mean ICU stay was 20.1+/-2.89 h. Postoperative complications included acute renal dysfunction (11), advanced atrioventricular block (9), and stroke (1). Thirty-six out of 42 (86%) patients were alive at the 6-month follow-up.


CONCLUSIONS
TAVI is feasible in high-risk patients who would not be able to undergo surgical valve replacement. Hemodynamic management is the main concern of intraoperative anesthesiological management. General or local anesthesia plus sedation are both valid alternative techniques that can be titrated according to patient characteristics. Close postoperative monitoring in the ICU is required.
Department of Anesthesia and Intensive Care, Vita-Salute San Raffaele University, Milan, Italy. covello.remodaniele@hsr.it
R D
RD
Covello
L
L
Ruggeri
G
G
Landoni
F
F
Guarracino
E
E
Bignami
M
M
Gonfalini
I
I
Virzo
I
I
Michev
A
A
Colombo
A
A
Zangrillo
D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D000777:Anesthetics; D000800:Angioplasty, Balloon; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001794:Blood Pressure / Q000502:physiology; D006328:Cardiac Catheterization; D000075202:Contraindications; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D016896:Treatment Outcome
D000777:Anesthetics