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Anaesthetic management of transcatheter aortic valve implantation.
MedLine Citation:
PMID:  22234024     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
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 significant 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. Anaesthetic strategies vary in different centers. Local anaesthesia or general anaesthesia are both valid alternatives and can be applied according to the patient's characteristics and procedural instances. General anaesthesia 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 anaesthesia 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 anaesthetic management of TAVI based on the available literature.
Authors:
Annalisa Franco; Chiara Gerli; Laura Ruggeri; Fabrizio Monaco
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of cardiac anaesthesia     Volume:  15     ISSN:  0974-5181     ISO Abbreviation:  Ann Card Anaesth     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-01-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9815987     Medline TA:  Ann Card Anaesth     Country:  India    
Other Details:
Languages:  eng     Pagination:  54-63     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic and Vascular Anaesthesia, Istituto Scientifico San Raffaele, Milan, India.
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