title: [Transcutaneous aortic valve implantation: Anesthetic and perioperative management].
abstract: OBJECTIVE
  To describe the perioperative management, from the point of view of the anesthesia-intensive care unit specialist, of patients with aortic stenosis who undergo transcatheter aortic valve implantation (femoral or apical TAVI).
  
  
  METHODS
  The PubMed database (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) was queried, using the following keywords: aortic stenosis, transcatheter aortic valve implantation TAVI, outcome, complications, anesthesia.
  
  
  RESULTS
  TAVI is performed in patients suffering from aortic stenosis and presenting with numerous comorbidities, high-predicted perioperative mortality and/or contraindications to conventional cardiac surgery. TAVI is performed either by percutaneous transfemoral or transapical puncture of the left ventricle (LV) apex. These patients are older, have more comorbidities than those undergoing aortic valve replacement surgery and perioperative mortality predicted by risk scores is higher. While transapical TAVI is performed with general anaesthesia, transfemoral TAVI can be performed with either general or locoregional anaesthesia and/or sedation. The choice of the anaesthetic technique for transfemoral TAVI depends on the patient's medical history, the technique chosen for valve implantation, the type of monitoring and the anticipated hemodynamic problems. The incidence of complications following TAVI is high, some are common to surgical aortic valve replacement, and others are specific to this technique. Because of the prevalence of comorbidities, the hemodynamic-specific constraints of this technique and the incidence of complications, anaesthetic and perioperative management (evaluation, anaesthetic technique, monitoring, post-surgery care) requires the same level of expertise as in cardiac surgery anaesthesia.
  
  
  CONCLUSIONS
  TAVI expands treatment options for patients with aortic valve stenosis. The anaesthesia team must be involved in the care of these patients with the same level of expertise and care as in heart surgery on critical patients.
authors: Département d'anesthésie-réanimation, hôpital Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, université Paris-7, 46, rue Henri-Huchard, 75877 Paris cedex 18, France.
authors: P-G
authors: PG
authors: Guinot
authors: J-P
authors: JP
authors: Depoix
authors: L
authors: L
authors: Tini
authors: A
authors: A
authors: Vahanian
authors: J-M
authors: JM
authors: Desmonts
authors: P
authors: P
authors: Montravers
authors: D
authors: D
authors: Longrois
mesh_terms: D000368:Aged; D000758:Anesthesia / Q000379:methods*; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D006328:Cardiac Catheterization; D002406:Catheterization, Peripheral; D015897:Comorbidity; D000075202:Contraindications; D003422:Critical Care; D005260:Female; D005268:Femoral Vein; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000401:mortality; D016343:Monitoring, Intraoperative; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D012307:Risk Factors; D016896:Treatment Outcome