Salvaging catastrophe in transcatheter aortic valve implantation: rehearsal, preassigned roles, and emergency preparedness.
OBJECTIVE
Emergency rescue plans for acute complications during transcatheter aortic valve implantation (TAVI) commonly include cardiopulmonary resuscitation, femoro-femoral cardiopulmonary bypass (CPB), and hemodynamic stabilization before definitive intervention is achieved. Nevertheless, most cases of emergency resuscitation remain chaotic and disorganized and often take longer than necessary, even in experienced centres. We sought to determine which factors and procedures may be associated with improved patient outcomes when emergencies arise during TAVI.


METHODS
MEDLINE(®) and EMBASE™ were searched with the following key words: "TAVI" or "TAVR" or "transcatheter valve implantation" or "transcatheter valve replacement" and "emergency cardiac surgery" or "conversion". Two hundred seventeen articles met the criteria and were reviewed.


RESULTS
Utilization of a formal emergency checklist by a multidisciplinary TAVI team may reduce procedural errors, smooth the transition to CPB, and ultimately speed the delivery of corrective measures including emergency cardiac surgery.


CONCLUSIONS
A well-organized regularly-rehearsed emergency rescue plan that preassigns resuscitative roles may shorten the duration of patient instability and resuscitation and improve patient outcomes when catastrophe occurs in TAVI. The anesthesia team plays a central role in preventing, detecting, and treating intraprocedural complications during TAVI.
Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Derrick Y
DY
Tam
Philip M
PM
Jones
Bob
B
Kiaii
Pantelis
P
Diamantouros
Patrick
P
Teefy
Daniel
D
Bainbridge
Andrew
A
Cleland
Philip
P
Fernandes
Michael W A
MW
Chu
D001021:Aortic Valve / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D002315:Cardiopulmonary Bypass; D016887:Cardiopulmonary Resuscitation; D002959:Civil Defense; D004632:Emergency Medical Services; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D010347:Patient Care Planning; D016896:Treatment Outcome