Anesthetic management of transcatheter aortic valve implantation

Annalisa Franco, Chiara Gerli, Laura Ruggeri, Fabrizio Monaco

Research output: Contribution to journalArticlepeer-review

Abstract

Transcatheter aortic valve implantation (TAVI) is an emergent technique for high-risk patients with aortic stenosis. TAVI poses significant challenges about its management because of the procedure itself and the population who undergo the implantation. Two devices are currently available and marketed in Europe and several other technologies are being developed. The retrograde transfemoral approach is the most popular procedure; nevertheless, it may not be feasible in patients with signicant aortic or ileo-femoral arterial disease. Alternatives include a transaxillary approach, transapical approach, open surgical access to the retroperitoneal iliac artery and the ascending aorta. A complementary approach using both devices and alternative routes tailored to the anatomy and the comorbidities of the single patient is a main component for the successful implementation of a TAVI program. Anesthetic strategies vary in different centers. Local anesthesia or general anesthesia are both valid alternatives and can be applied according to the patient's characteristics and procedural instances. General anesthesia offers many advantages, mainly regarding the possibility of an early diagnosis and treatment of possible complications through the use of transesophageal echocardiography. However, after the initial experiences, many groups began to employ, routinely, sedation plus local anesthesia for TAVI, and their procedural and periprocedural success demonstrates that it is feasible. TAVI is burdened with potential important complications: vascular injuries, arrhythmias, renal impairment, neurological complications, cardiac tamponade, prosthesis malpositioning and embolization and left main coronary artery occlusion. The aim of this work is to review the anesthetic management of TAVI based on the available literature.

Original languageEnglish
Pages (from-to)54-63
Number of pages10
JournalAnnals of Cardiac Anaesthesia
Volume15
Issue number1
DOIs
Publication statusPublished - Jan 2012

Keywords

  • Anesthesia
  • aortic stenosis
  • transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Cardiology and Cardiovascular Medicine

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