Document Detail


Percutaneous aortic valve implants under sedation: our initial experience.
MedLine Citation:
PMID:  19021273     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We have developed an approach where percutaneous aortic valve (PAVI) procedures are done under remifentanil-based sedation administered by an anesthetist. We report here our initial experience. BACKGROUND: Percutaneous aortic valve implantation is proving to be an effective treatment for aortic stenosis in patients with significant comorbidity precluding surgical aortic valve replacement. Most PAVIs have been done under general anesthetic with transoesophageal echocardiography (TOE). General anesthesia in this patient group is hazardous and associated with significant complications. METHODS AND RESULTS: CoreValve implantation was performed via the retrograde approach in 12 patients at our cardiothoracic center between December 2007 and May 2008. Three had the procedure under general anesthetic and nine under sedation. There were no differences between the groups in terms of comorbidities and clinical characteristics. The procedure was visualized using fluoroscopic aortic calcification coupled with multiple small volume aortograms. One patient converted from sedation to general anesthetic during the procedure. One patient in the general anesthetic group died from respiratory complications. There were no significant differences in procedural success, procedure time, or hospital stay between the two groups. CONCLUSION: Percutaneous aortic valve implantation can, in the majority of cases, be performed under remifentanil-based sedation. Our initial experience suggests that this should result in a shorter implant procedure time, reduced stay in high dependency areas, and shorter time to hospital discharge.
Authors:
Miles Behan; Peter Haworth; Nevil Hutchinson; Uday Trivedi; Jean-Claude Laborde; David Hildick-Smith
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  72     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-12-01     Completed Date:  2009-02-26     Revised Date:  2009-06-25    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1012-5     Citation Subset:  IM    
Copyright Information:
Copyright 2008 Wiley-Liss, Inc.
Affiliation:
Sussex Cardiac Centre, Brighton and Sussex University Hospital NHS Trust, Eastern Road, Brighton UK, BN2 5BE.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Anesthesia, General* / adverse effects
Aortic Valve / pathology,  surgery*
Aortic Valve Stenosis / pathology,  surgery*
Balloon Dilatation
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation* / adverse effects,  instrumentation
Humans
Hypnotics and Sedatives / adverse effects,  therapeutic use*
Length of Stay
Male
Piperidines / adverse effects,  therapeutic use*
Prosthesis Design
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Hypnotics and Sedatives; 0/Piperidines; 132875-61-7/remifentanil
Comments/Corrections
Comment In:
Catheter Cardiovasc Interv. 2009 Jul 1;74(1):148-9; author reply 150   [PMID:  19360874 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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