title: Local anaesthesia with analgosedation in patients qualified for transcatheter aortic valve implantation (TAVI): first institute's results and experiments.
abstract: BACKGROUND
  The authors present their own experience of the treatment of patients qualified for transcatheter aortic valve implantation (TAVI) carried out in a modern hybrid operating room. The objective of the present study was to demonstrate the initial results of conducting anaesthesia in high-risk patients qualified for the TAVI procedure (transcatheter aortic valve implantation). In addition, the authors' aim was also to point out to the special challenges of an anaesthesiologist conducting local anaesthesia in such a type of procedures and to evaluate the safety and efficacy of the TAVI procedure conducted under remifentanil analgosedation.
  
  
  METHODS
  A retrospective analysis included patients treated during the period from September 2015, when local anaesthesia for the transcatheter aortic valve implantation was used for the first time at our centre, up to February 2016. The studied population consisted of 11 patients treated for severe aortic valve stenosis. The mean age of patients was 80 ± 7 years. Three patients were men (27%) and eight were women (73%). The study included all subsequent patients (n = 11), treated in our centre, for whom it was decided to perform TAVI under local anaesthesia.
  
  
  RESULTS
  The total hospital mortality rate was 0%. All procedures were performed in a hybrid operating room. Despite the complications observed in the described group, the hospital mortality rate during TAVI was 0%. All patients, after 12 ± 5 days of treatment, left the hospital in a good neurological condition, which was assessed based on the CPC-1 (Cerebra Performance Categories Scale) and GCS-15 (Glasgow Coma Scale) scales. With an ejection fraction of the left ventricle of 53 ± 11%, the transcatheter aortic valve was successfully implanted.
  
  
  CONCLUSIONS
  Percutaneous aortic valve implantation can be successfully conducted under remifentanil analgosedation. TAVI procedures should be performed in the conditions of a modern, well-equipped hybrid room. The aim of the anaesthesiologist should consist of conducting the least invasive anaesthesia/analgesia, bearing in mind the safety and comfort of the patient.
authors.affiliation: Department of Anaesthesiology and Intensive Therapy, John Paul II Hospital, Cracow, Poland. r.musial@aclex.com.pl.
authors.forename: Robert
authors.initials: R
authors.lastname: Musiał
authors.forename: Magdalena
authors.initials: M
authors.lastname: Lipińska-Strasik
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Piątkiewicz
authors.forename: Jarosław
authors.initials: J
authors.lastname: Stoliński
authors.forename: Rafał
authors.initials: R
authors.lastname: Drwiła
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage*; D000077208:Remifentanil; D012189:Retrospective Studies; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods*
chemical_list: D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil
keywords: aortic stenosis; aortic valve replacement; local anaesthesia; percutaneous cardiac surgery