Document Detail

Anesthetic management of transcatheter aortic valve implantation with transaxillary approach.
MedLine Citation:
PMID:  21036065     Owner:  NLM     Status:  In-Data-Review    
OBJECTIVE: To describe the anesthetic management of transcatheter aortic valve implantation (TAVI) with the transaxillary approach.
DESIGN: An observational cohort study.
SETTING: Two university hospitals.
PARTICIPANTS: Twenty-two patients with severe aortic stenosis (± regurgitation) at high risk for surgical valve replacement, with contraindications for transfemoral TAVI (81 ± 4.9 years; logistic EuroSCORE, 27% ± 16.9%).
INTERVENTION: General anesthesia or local anesthesia plus sedation followed by postoperative care.
MEASUREMENTS AND MAIN RESULTS: Local anesthesia plus sedation and general anesthesia were used in 14 and 8 patients, respectively. Two patients undergoing local anesthesia were monitored with transesophageal echocardiography and supported with noninvasive mask ventilation during the procedure. Main complications included hemodynamic instability requiring inotropes (2 patients), severe postimplant aortic regurgitation requiring immediate second valve-in-valve implantation (1 patient), valve embolization requiring open-valve surgery (1 patient), subclavian artery dissection compromising the flow to a mammary artery graft (1 patient), ascending aortic dissection (1 patient), stroke (2 patients), and atrioventricular block requiring pacemaker implantation (3 patients). Four patients experienced an increased (baseline value × 1.5) postoperative serum creatinine. Five patients required red blood cell tranfusions (2 units). Intensive care unit stay and hospital stay were 6 (4-23) hours and 8 (8-9) days, respectively. All patients were alive 30 days after the procedure. The 6-month mortality was 9%.
CONCLUSIONS: Transaxillary TAVI is feasible in high-risk patients with aortic stenosis and peripheral vasculopathy. Nevertheless, severe procedural complications are possible, and anesthesiologists should be prepared to assist in the management of these conditions.
Fabio Guarracino; Remo Daniel Covello; Giovanni Landoni; Rubia Baldassarri; Maurizio Stefani; Claudia Cariello; Laura Ruggeri; Annalisa Franco; Chiara Gerli; Frederico Pappalardo; Alberto Zangrillo
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Publication Detail:
Type:  Journal Article     Date:  2010-10-29
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  25     ISSN:  1532-8422     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  437-43     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Cardiothoracic Anaesthesia and Intensive Care Medicine, Cardiothoracic Department, University Hospital of Pisa, Pisa, Italy.
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