title: Anesthesia and perioperative management of patients undergoing transcatheter aortic valve implantation: analysis of 90 consecutive patients with focus on perioperative complications.
abstract: OBJECTIVE
  To describe, from the point of view of anesthesia and intensive care specialists, the perioperative management of high-risk patients with aortic stenosis who underwent transcatheter (transfemoral and transapical) aortic valve implantation (TAVI). The authors specifically focused on immediate postoperative complications.
  
  
  METHODS
  Retrospective review of collected data.
  
  
  METHODS
  Academic hospital.
  
  
  METHODS
  Ninety consecutive patients with severe aortic stenosis who underwent TAVI.
  
  
  METHODS
  General anesthesia followed by postoperative care. Complications were defined by pre-established criteria.
  
  
  RESULTS
  Of 184 patients referred between October 2006 and February 2009, 90 were consecutively treated with TAVI because of a high surgical risk or contraindications to surgery. The transfemoral approach was used as the first option (n = 62), and the transapical approach when contraindications to the former were present (n = 28). Results are presented as mean ± standard deviation or median (25-75 percentiles) as appropriate. Patients were 81 ± 8 years old, in New York Heart Association classes II (9%), III (54 %), or IV (37%); left ventricular ejection fraction was below 0.5 in 38% of patients. The predicted surgical mortality was 24% (16-32) and 15% (11-23) with the logistic EuroSCORE and STS-Predicted Risk of Mortality, respectively. The valve was implanted in 92% of the cases. The duration of anesthesia and (intra- and postoperative) mechanical ventilation was 190 (160-230) minutes and 245 (180-420) minutes, respectively. Hospital mortality was 11%. The most frequent cardiac complications were heart failure (20%) and atrioventricular block (16%), with 6% requiring a pacemaker. Vascular complications (major and minor) occurred in 29% of the patients.
  
  
  CONCLUSIONS
  Despite their severe comorbidities, the mortality of the patients in this cohort was below that predicted by cardiac surgery risk scores. Monitoring, hemodynamic instability, and the frequency of complications require management and follow-up of these patients in similar ways as for open cardiac surgery. The frequency of complications in this cohort was comparable to that published by other groups.
authors.affiliation: Department of Anesthesia and Intensive Care, Bichat-Claude Bernard Hospital, University Paris 7, Paris, France.
authors.forename: Pierre-Grégoire
authors.initials: PG
authors.lastname: Guinot
authors.forename: Jean-Pol
authors.initials: JP
authors.lastname: Depoix
authors.forename: Laure
authors.initials: L
authors.lastname: Etchegoyen
authors.forename: Abdel
authors.initials: A
authors.lastname: Benbara
authors.forename: Sophie
authors.initials: S
authors.lastname: Provenchère
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Dilly
authors.forename: Ivan
authors.initials: I
authors.lastname: Philip
authors.forename: Daniel
authors.initials: D
authors.lastname: Enguerand
authors.forename: Hassan
authors.initials: H
authors.lastname: Ibrahim
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.forename: Nawaar
authors.initials: N
authors.lastname: Al-Attar
authors.forename: Patrick
authors.initials: P
authors.lastname: Nataf
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Desmonts
authors.forename: Philippe
authors.initials: P
authors.lastname: Montravers
authors.forename: Dan
authors.initials: D
authors.lastname: Longrois
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects* / Q000401:mortality; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000401:mortality; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies