Anesthetic management of transcatheter aortic valve implantation

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose of Review: The revolution in transcatheter aortic valve implantation (TAVI) for the treatment of aortic stenosis has been well described by the large number of randomized trials, registries, and single and multicenter experiences published during 2010-2011. The aim of this review is to describe the challenges of the anesthetic management related to TAVI. Recent Findings: Recent data show that TAVI is clinically effective in patients with inoperable aortic stenosis when compared with standard therapy. It can be accomplished in high-risk patients with favorable outcomes compared with surgery as predicted by standard estimates of mortality and is associated with functional and hemodynamic improvement. Currently, TAVI is targeted at high-risk patients, but may be extended to lower risk groups in the near future. Outstanding questions concerning TAVI are related to its long-term durability and to procedural complications. Summary: Preprocedural, multidisciplinary assessment of the patient is essential prior to TAVI and should include a full anesthetic evaluation, consideration of patient comorbidities, and determination of technical feasibility. The role of scoring systems for risk prediction requires further scrutiny. Multidevice/multiple access approaches allow for treatment of a wide range of patients. Anesthetic techniques and supportive measures vary depending on procedural concerns, patient comorbidity, and severe, often unstable cardiac disease. Echocardiography is fundamental to preoperative evaluation, procedure guidance, and assessment of complications. Planned bailout strategies should be discussed with all members of the medical team. Postoperative standardized monitoring and management protocols are essential.

Original languageEnglish
Pages (from-to)417-425
Number of pages9
JournalCurrent Opinion in Anaesthesiology
Volume24
Issue number4
DOIs
Publication statusPublished - Aug 2011

Keywords

  • anesthesia
  • aortic stenosis
  • complications
  • transcatheter aortic valve implantation
  • transesophageal echocardiography

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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