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Tanner R, Giacoppo D, Saber H, Barton D, Sugrue D, Roy A, Blake G, Spence MS, Margey R, Casserly IP. Trends in transcatheter aortic valve implantation practice and clinical outcomes at an Irish tertiary referral centre. Open Heart 2024; 11:e002610. [PMID: 38538065 PMCID: PMC10982748 DOI: 10.1136/openhrt-2024-002610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 02/16/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE A paucity of data exists on how transcatheter aortic valve implantation (TAVI) practice has evolved in Ireland. This study sought to analyse temporal trends in patient demographics, procedural characteristics, and clinical outcomes at an Irish tertiary referral centre. METHODS The prospective Mater TAVI database was divided into time tertiles based on when TAVI was performed: Group A, November 2008-April 2013; Group B, April 2013-September 2017; and Group C, September 2017-February 2022. Patient and procedural characteristics and clinical outcomes were compared across groups. RESULTS A total of 1063 (Group A, 59; Group B, 268; and Group C:, 736) patients were treated with TAVI during the study period (mean age 81.1±7.4, mean Society of Thoracic Surgeons score 5.9±5.1).Conscious sedation (Group A, 0%; Group B, 59.9%; and Group C, 90.2%, p<0.001) and femoral artery access (Group A, 76.3%; Group B, 90.7%; and Group C, 96.6%, p<0.001) were used more frequently over time. The median length of hospital stay reduced from 9 days (IQR 7, 18) in Group A to 2 days (IQR 2, 3) in Group C. In-hospital death was numerically higher in Group A compared with Group C (6.8% vs 1.9%, p=0.078). At 1-year follow-up, the rate of death and/or stroke was similar in Group A and Group C (20.3% vs 12.0%, adjusted HR 1.49, 95% CI (0.59 to 3.74)). CONCLUSION There was exponential growth in TAVI procedural volume during the study period. A minimalist approach to TAVI emerged, and this was associated with significantly shorter procedure duration and hospital stay. Clinical outcomes at 1-year follow-up did not change significantly over time.
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Affiliation(s)
- Richard Tanner
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Daniele Giacoppo
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Hassan Saber
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - David Barton
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Declan Sugrue
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Andrew Roy
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Gavin Blake
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Mark S Spence
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Ronan Margey
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
| | - Ivan P Casserly
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
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Fadah K, Khalafi S, Corey M, Sotelo J, Farag A, Siddiqui T, Abolbashari M. Optimizing Anesthetic Selection in Transcatheter Aortic Valve Replacement: Striking a Delicate Balance between Efficacy and Minimal Intervention. Cardiol Res Pract 2024; 2024:4217162. [PMID: 38454917 PMCID: PMC10919973 DOI: 10.1155/2024/4217162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/27/2024] [Indexed: 03/09/2024] Open
Abstract
Patients with severe calcific native aortic valve stenosis (AS) who require valve replacement have two options, surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). TAVR was approved in late 2011 for extremely high-risk patients and was subsequently approved for high-risk (2012), intermediate-risk (2016), and low-risk (2019) patients. In 2019, TAVR procedures surpassed SAVR procedures for the first time in the United States. The approach to anesthesia for this procedure has also evolved. Initially, general anesthesia (GA) was preferred, but currently, conscious sedation (CS) is favored. This review aims to clarify the indications and contraindications for both approaches, as well as the advantages of one approach over the other. Recent studies show that conscious sedation has better outcomes in terms of all-cause mortality, procedure complications such as stroke, myocardial infarction, infection requiring antibiotics, acute kidney injury, and the need for inotropes or vasopressors.
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Affiliation(s)
- Kahtan Fadah
- Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79905, USA
| | - Seyed Khalafi
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, 5001 El Paso Drive, El Paso, TX 79905, USA
| | - Miller Corey
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, 5001 El Paso Drive, El Paso, TX 79905, USA
| | - Jose Sotelo
- Department of Internal Medicine, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79905, USA
| | - Ahmed Farag
- Department of Internal Medicine, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79905, USA
| | - Tariq Siddiqui
- Tash Medical Clinic, 7812 Gateway Blvd E, El Paso, TX 79915, USA
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Prophylactic Awake Peripheral V-A ECMO during TAVR. J Clin Med 2023; 12:jcm12030859. [PMID: 36769507 PMCID: PMC9918165 DOI: 10.3390/jcm12030859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION TAVR remains a complex procedure that may result in serious intraprocedural complications. In many of these circumstances, venoarterial extracorporeal membrane oxygenation (V-A ECMO) helps to manage complications, provides a hemodynamic back-up, and bridges to an emergency open heart surgery. The clinical outcomes of 27 patients who underwent prophylactic implantation of peripheral V-A ECMO (pV-A ECMO) during high-risk transcatheter aortic valve replacement (TAVR) cases are described. METHODS From June 2012 to October 2022, 590 consecutive patients underwent TAVR at our center. Of these, 27 patients (4.5%) underwent TAVR with pV-AECMO because they were deemed very high risk for periprocedural complications and formed the study population. RESULTS There were no pV-A ECMO, hemodynamic or TAVR implantation complications. Decannulation of the ECMO system was performed in 92.6% of cases at the end of the procedure in the hybrid-operating theatre. The mean duration of pV-A ECMO for procedure support was 51.4 ± 10.3 min. There were no ECMO-related vascular or bleeding complications. CONCLUSION This study shows that the prophylactic placement of awake peripheral V-A ECMO provides excellent temporary cardio-circulatory and pulmonary support during very high-risk TAVR procedures.
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Wang L, Liu Y, Gao H, Zhang B, Zhou S, Xie M, Sun X. Comparison of Safety and Effectiveness of Local or General Anesthesia after Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12020508. [PMID: 36675437 PMCID: PMC9866516 DOI: 10.3390/jcm12020508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/26/2022] [Accepted: 12/31/2022] [Indexed: 01/11/2023] Open
Abstract
It remains controversial to choose anesthesia for transcatheter aortic valve implantation (TAVI). A meta-analysis of cohort studies was conducted to assess the efficacy and safety of local anesthesia (LA) compared to general anesthesia (GA) in TAVI. All relevant studies published from 1 January 2002, to 31 June 2022, were searched in Ovid, PubMed, Embase, Web of Science, and Cochrane Library. A total of 34 studies involving 23,480 patients were included in the meta-analysis. TAVI with LA was associated with a significant reduction in hospital stay [WMD = −2.48, 95% CI (−2.80, −2.16), p < 0.00001], operative [WMD = −12.25, 95% CI (−13.73, −10.78), p < 0.00001] and fluoroscopy time [WMD = −3.30, 95% CI (−5.40, −1.19), p = 0.002], and an increased risk of acute kidney injury [OR = 1.31, 95% CI (1.01, 1.69), p = 0.04] and a reduced incidence of major bleeding [OR = 0.59, 95% CI (0.46, 0.75), p < 0.0001] and the use of cardiovascular drugs [OR = 0.17, 95% CI (0.05, 0.57), p = 0.004]. No differences were found between LA and GA for 30-day mortality, procedural success rate, myocardial infarction, permanent pacemaker implantation, paravalvular leak, shock, and cerebrovascular events. Overall, 4.4% of LA converted to GA. Based on current evidence, our results suggested that LA strategies reduced hospital stay, operative time, fluoroscopy time, cardiovascular drug consumption, and major bleeding rates in patients undergoing TAVI but led to increased acute kidney injury rates. Further studies and randomized trials are required to verify the presented findings and to identify patients who might benefit from LA.
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Angelillis M, Stazzoni L, Costa G, Giannini C, Primerano C, Spontoni P, Pieroni A, Guarracino F, Bertini P, Baldassarri R, De Carlo M, Petronio AS. Transcatheter aortic valve replacement with or without anesthesiologist: results from a high-volume single center. J Cardiovasc Med (Hagerstown) 2022; 23:801-806. [PMID: 36219144 DOI: 10.2459/jcm.0000000000001391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Local instead of general anesthesia has become the standard approach in many centers for transfemoral transcatheter aortic valve replacement (TAVR). New generation devices and an increase in operator skills had led to a drastic reduction in periprocedural complications, bringing in the adoption of a minimalist approach. In our study, we aimed to compare patients treated with TAVR under local anesthesia with or without the presence of an anesthesiologist on site (AOS). METHODS We compare procedural aspects and results of patients treated with TAVR with an AOS against patients treated with TAVR with an anesthesiologist on call (AOC). From January 2019 to December 2020, all consecutive patients undergoing transfemoral TAVR with either the self-expandable Evolut (Medtronic, MN, USA) or balloon-expandable SAPIEN 3 (Edwards Lifesciences, CA, USA) were collected. RESULTS Of 332 patients collected, 96 (29%) were treated with TAVR with AOS, while 236 (71%) were treated with TAVR with AOC. No differences in procedural time, fluoroscopy time and amount of contrast medium were observed. No procedural death and conversion to open-chest surgery was reported. The rate of stroke/transient ischemic attacks and major vascular complications was similar in the two groups. No patients in both groups required conversion to general anesthesia. Two patients (0.8%) in the AOC group required urgent intervention of the anesthesiologist. In the AOC group, there was a greater use of morphine (55.9% vs. 33.3%, P = 0.008), but with a lower dose for each patient (2.0 vs. 2.8 mg, P = 0.006). On the other hand, there was a lower use of other painkiller drugs (3.4% vs. 20.8%, P = 0.001). No difference in inotropic drugs use was observed. CONCLUSION In patients at low or intermediate risk undergoing transfemoral TAVR, a safe procedure can be performed under local anesthesia without the presence of an anesthesiologist in the catheterization laboratory.
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Affiliation(s)
- Marco Angelillis
- Catheterization laboratory, Cardiothoracic and Vascular Department
| | - Laura Stazzoni
- Catheterization laboratory, Cardiothoracic and Vascular Department
| | - Giulia Costa
- Catheterization laboratory, Cardiothoracic and Vascular Department
| | | | - Chiara Primerano
- Catheterization laboratory, Cardiothoracic and Vascular Department
| | - Paolo Spontoni
- Catheterization laboratory, Cardiothoracic and Vascular Department
| | - Andrea Pieroni
- Catheterization laboratory, Cardiothoracic and Vascular Department
| | - Fabio Guarracino
- Cardiothoracic and vascular Anaesthesiology and Intensive Care, Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Pietro Bertini
- Cardiothoracic and vascular Anaesthesiology and Intensive Care, Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Rubia Baldassarri
- Cardiothoracic and vascular Anaesthesiology and Intensive Care, Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marco De Carlo
- Catheterization laboratory, Cardiothoracic and Vascular Department
| | - Anna S Petronio
- Catheterization laboratory, Cardiothoracic and Vascular Department
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Update on Minimalist TAVR Care Pathways: Approaches to Care in 2022. Curr Cardiol Rep 2022; 24:1179-1187. [PMID: 35767177 PMCID: PMC9244066 DOI: 10.1007/s11886-022-01737-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2022] [Indexed: 11/20/2022]
Abstract
Purpose of Review This review summarizes current data supporting a minimalist TAVR approach and identifies the need for additional study to optimize TAVR care. The authors discuss future directions of the TAVR landscape and how this necessitates evolution of minimalist care pathways. Recent Findings Transcatheter aortic valve replacement (TAVR) has become a mainstay in the treatment of aortic stenosis since the initial procedure in 2002. Recently, attention has shifted to TAVR optimization and the minimalist approach with a focus on minimizing procedural sedation, protocolization of perioperative management, and prioritization on early discharge. This approach has been shown to be safe and reduce procedure time, length of stay, and overall cost for hospital systems. Summary The minimalist care pathway avoids general anesthesia, shortens procedure time and length of stay, and reduces cost without changing mortality or readmission rates at 30 days. A variety of protocols have been proposed without a clear consensus on specific components or patient eligibility. There is a continued need for data regarding patient risk stratification, valve selection, and discharge strategy as TAVR becomes increasingly common.
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Kočka V, Nováčková M, Kratochvílová L, Širáková A, Sulženko J, Buděšínský T, Bystroń M, Neuberg M, Mašek P, Bednář F, Stern M, Toušek AP. OUP accepted manuscript. Eur Heart J Suppl 2022; 24:B23-B27. [PMID: 35370506 PMCID: PMC8971737 DOI: 10.1093/eurheartjsupp/suac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has become a high-volume procedure with increasing demands on hospital resources. Local anaesthesia with sedation supervised by an anaesthesiology team is the current standard of care. We aimed to describe our experience with a simplified, nurse-led sedation (NLS) protocol. This study enrolled 128 consecutive patients who underwent transfemoral TAVI with self-expandable Evolut R prosthesis between November 2019 and April 2021. Operators selected 50% of patients for NLS based on the clinical expectation of lower risk of procedural difficulties. Nurse-led sedation protocol demanded only mild to moderate levels of sedation. The clinical outcomes were determined from the local TAVI registry and the national mortality database. Baseline patient characteristics were similar in the NLS (n = 64) and anaesthesiologist-led sedation (ALS) (n = 64) groups except higher prevalence of diabetes mellitus (48.4% vs. 31.3%, P = 0.035) and peripheral vascular disease (20.3% vs. 7.8%, P = 0.036) in the ALS group. There was a trend for the larger prostheses used in the ALS group (P = 0.058). The procedural results did not differ, and coronary care team backup was rarely needed in the NLS group (6% of patients). The in-hospital outcomes were identical from both clinical and echocardiography perspectives, and 30-day mortality was low in both groups (1.5%). For the NLS group, preparation in the catheterization laboratory was quicker by 6.4 min (P = 0.01), and intensive care unit stay was shorter (2.03 vs. 3.48 days, P = 0.001). In conclusion, the NLS for the selected transfemoral TAVI population seems safe.
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Affiliation(s)
- Viktor Kočka
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Šrobárova 50, Prague 100 34, Czech Republic
- Corresponding author. Tel: +420 267 162 701,
| | - Markéta Nováčková
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Šrobárova 50, Prague 100 34, Czech Republic
| | | | - Andrea Širáková
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Šrobárova 50, Prague 100 34, Czech Republic
| | - Jakub Sulženko
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Šrobárova 50, Prague 100 34, Czech Republic
| | - Tomáš Buděšínský
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Šrobárova 50, Prague 100 34, Czech Republic
| | - Marian Bystroń
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Šrobárova 50, Prague 100 34, Czech Republic
| | - Marek Neuberg
- Medtronic Czechia, Prosecká 66, Prague 190 00, Czech Republic
| | - Petr Mašek
- Medtronic Czechia, Prosecká 66, Prague 190 00, Czech Republic
| | - František Bednář
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Šrobárova 50, Prague 100 34, Czech Republic
| | - Michael Stern
- Department of Anaesthesia and Intensive Care Medicine, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Šrobárova 50, Prague 100 34, Czech Republic
| | - and Petr Toušek
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Šrobárova 50, Prague 100 34, Czech Republic
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Patel P, Jundi L, Li D, Liu H. Is a designated arterial catheter indicated in transcatheter aortic valve replacement procedure? J Biomed Res 2022; 36:73-76. [PMID: 35387903 PMCID: PMC9002161 DOI: 10.7555/jbr.36.20220036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Pooja Patel
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA 95817, USA
| | - Lillian Jundi
- California Northstate University College of Medicine, Sacramento, CA 95757, USA
| | - David Li
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA 95817, USA
| | - Hong Liu
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA 95817, USA
- Hong Liu, Department of Anesthesiology and Pain Medicine, University of California Davis Health, 4150 V Street, Suite 1200, Sacramento, CA 95817, USA. Tel/Fax: +1-916-734-5031/+1-916-734-7980, E-mail:
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Rao RS, Sharma S, Mehta N, Bana A, Chaturvedi H, Gupta R, Varshney P, Gadhwal K, Saran D, Diwedi P. Single-center experience of 105-minimalistc transfemoral transcatheter aortic valve replacement and its outcome. Indian Heart J 2021; 73:301-306. [PMID: 34154746 PMCID: PMC8322745 DOI: 10.1016/j.ihj.2021.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/11/2020] [Accepted: 01/29/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) increases worldwide, and indications expand from high-risk aortic stenosis patients to low-risk aortic stenosis. Studies have shown that minimalistic TAVR done under conscious sedation is safe and effective. We report single-operator, the single-center outcome of 105 minimalist transfemoral, conscious sedation TAVR patients, analyzed retrospectively. METHODS All patients underwent TAVR in cardiac catheterization lab via percutaneous transfemoral, conscious sedation approach. A dedicated cardiac anesthetist team delivered the conscious sedation with a standard protocol described in the main text. The outcomes were analyzed as per VARC-2 criteria and compared with the latest low-risk TAVR trials. RESULTS A total of 105 patients underwent transcatheter aortic valve replacement between July 2016 to February 2020. The mean age of the population was 73 years, and the mean STS score was 3.99 ± 2.59. All patients underwent a percutaneous transfemoral approach. Self-expanding valve was used in 40% of cases and balloon-expandable valve in 60% (Sapien3™ in 31% and MyVal™ in 29%) of cases. One patient required conversion to surgical aortic valve replacement. The success rate was 99 percent. The outcomes were: all-cause mortality: 0.9%, stroke rate 1.9%, New pacemaker rate 5.7%, 87.6% had no paravalvular leak. The mild and moderate paravalvular leak was seen in 2.8% and 1.9%, respectively. The mean gradient decreased from 47.5 mmHg to 9 mmHg. The average ICU stay was 26.4 h, and the average hospital stay was 5.4 days. Our outcomes are comparable with the latest published low-risk trial. CONCLUSION Minimalist, conscious sedation, transfemoral transcatheter aortic valve replacement when done following a standard protocol is safe and effective.
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Affiliation(s)
- Ravinder Singh Rao
- Structural Heart Disease and TAVR Program, Interventional Cardiology, Eternal Hospital, Jaipur, India.
| | - Samin Sharma
- Eternal Hospital Jaipur, International Clinical Affiliations, Clinical and Interventional Cardiology, Mount Sinai Hospital, New York, USA
| | - Navneet Mehta
- Department of Cardiac Anesthesia, Eternal Hospital, Jaipur, India
| | - Ajeet Bana
- Department of Cardiothoracic Surgery, Eternal Hospital, Jaipur, India
| | - Hemant Chaturvedi
- Department of Non-Invasive Cardiology, Eternal Hospital, Jaipur, India
| | - Rajeev Gupta
- Department of Internal Medicine, Eternal Hospital, Jaipur, India
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Neuburger PJ, Pospishil L, Ibrahim H. Anesthetic Management of Conduction Disturbances Following Transcatheter Aortic Valve Replacement: A Review of the 2020 ACC Expert Consensus Decision Pathway. J Cardiothorac Vasc Anesth 2021; 35:982-986. [PMID: 33441272 DOI: 10.1053/j.jvca.2020.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Peter J Neuburger
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY.
| | - Liliya Pospishil
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Homam Ibrahim
- Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, NY
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Keegan P, Lisko JC, Kamioka N, Maidman S, Binongo JN, Wei J, Vadlamudi R, Edwards JK, Vatsa N, Maini A, Reginauld S, Gleason P, Stewart J, Devireddy C, Block PC, Greenbaum A, Guyton RA, Babaliaros VC. Nurse Led Sedation: The Clinical and Echocardiographic Outcomes of the 5-Year Emory Experience. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2020. [DOI: 10.1080/24748706.2020.1773591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Patricia Keegan
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John C. Lisko
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Norihiko Kamioka
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Samuel Maidman
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jose N. Binongo
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jane Wei
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ratna Vadlamudi
- Division of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - J. Kirk Edwards
- Division of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Aneesha Maini
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shawn Reginauld
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Patrick Gleason
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - James Stewart
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chandan Devireddy
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Peter C. Block
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Adam Greenbaum
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert A. Guyton
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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Saia F, Palmerini T, Marcelli C, Chiarabelli M, Taglieri N, Ghetti G, Negrello F, Moretti C, Bruno AG, Compagnone M, Corsini A, Castelli A, Marrozzini C, Galiè N. Routine minimalist transcatheter aortic valve implantation with local anesthesia only. J Cardiovasc Med (Hagerstown) 2020; 21:805-811. [DOI: 10.2459/jcm.0000000000001030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
Transcatheter aortic valve replacement (TAVR) is a minimally invasive approach to treat symptomatic severe aortic stenosis. The patient populations that have been shown to benefit from this procedure continue to grow with time. Techniques and technology in TAVR persistently advance with a continued trend toward improved outcomes for patients. In this review, we highlight the advances in vascular access, TAVR valve design, progress in reducing procedural complications, and emerging evidence in the field.
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Affiliation(s)
- Morgan H Randall
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Anthony A Bavry
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA.
- North Florida/South Georgia, Veterans Health System, Gainesville, FL, USA.
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Anderson RD, Gargus N, Randall MH. Editorial: The use of Fascia iliaca Block with Minimal Conscious Sedation in Transcatheter Aortic Valve Replacement: Advances in TAVR Anesthesia. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:602-603. [PMID: 32201210 DOI: 10.1016/j.carrev.2020.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/10/2020] [Indexed: 11/19/2022]
Affiliation(s)
- R David Anderson
- University of Florida, Division of Cardiovascular Medicine, 1329 SW 16th St., PO Box 100288, Gainesville, FL 32608, United States of America.
| | - Nathan Gargus
- University of Florida, Division of Cardiovascular Medicine, 1329 SW 16th St., PO Box 100288, Gainesville, FL 32608, United States of America
| | - Morgan H Randall
- University of Florida, Division of Cardiovascular Medicine, 1329 SW 16th St., PO Box 100288, Gainesville, FL 32608, United States of America
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15
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Tanaka CY, Hartman KM, Patel PA, Neuburger PJ. Anesthesiologists Can Add Value in Transcatheter Aortic Valve Replacement by Performing Transthoracic Echocardiography. J Cardiothorac Vasc Anesth 2020; 34:32-34. [DOI: 10.1053/j.jvca.2019.06.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 06/28/2019] [Indexed: 11/11/2022]
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16
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Witberg G, Patterson T, Redwood S, Prendergast B. Perspectivas futuras. Implante percutáneo de válvula aórtica para pacientes en bajo riesgo: ¿una realidad a corto plazo o se debe esperar? Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2019.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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17
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Witberg G, Patterson T, Redwood S, Prendergast B. Future Directions. Transcatheter Aortic Valve Implantation for Low-risk Patients: Inevitable Evolution or a Step Too Far? ACTA ACUST UNITED AC 2019; 72:664-671. [PMID: 30930254 DOI: 10.1016/j.rec.2019.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 02/15/2019] [Indexed: 11/29/2022]
Abstract
Transcatheter aortic valve replacement has become the treatment of choice for inoperable and high-risk patients with symptomatic aortic stenosis, and is becoming more and more common as the first choice for intermediate-risk patients as well. The next step in this evolution would be the expansion of treatment indications to low-risk patients. Successful treatment of this patient population will require setting new standards in terms of clinical outcomes and cost effectiveness. In this review, we present the main challenges that need to be addressed before transcatheter aortic valve replacement can be applied as a standard treatment for low-risk patients.
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Affiliation(s)
- Guy Witberg
- Department of Cardiology, St Thomas' Hospital, London, United Kingdom.
| | - Tiffany Patterson
- Department of Cardiology, St Thomas' Hospital, London, United Kingdom
| | - Simon Redwood
- Department of Cardiology, St Thomas' Hospital, London, United Kingdom
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18
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Droppa M, Borst O, Katzenberger T, Krause R, Grasshoff C, Gawaz M, Geisler T. Comparison of safety and periprocedural complications of transfemoral aortic valve replacement under local anaesthesia: minimalist versus complete Heart Team. EUROINTERVENTION 2019; 14:e1819-e1825. [DOI: 10.4244/eij-d-18-00795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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19
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Raffa GM, Kowalewski M, Meani P, Follis F, Martucci G, Arcadipane A, Pilato M, Maessen J, Lorusso R, Turrisi M, Gandolfo C, Montalbano G, Cannata S, Coco VL, Armaro A, Stringi V, Romano G, Falletta C, Delnoij T, Gilbers M, Heuts S, Schreurs R, Jiritano F, Matteucci M, Fina D. In-hospital outcomes after emergency or prophylactic veno-arterial extracorporeal membrane oxygenation during transcatheter aortic valve implantation: a comprehensive review of the literature. Perfusion 2019; 34:354-363. [DOI: 10.1177/0267659118816555] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has been used to deal with life-threatening complications as well as back-up or active cardiovascular support during high-risk procedures in patients undergoing transcatheter aortic valve implantation (TAVI). PubMed and MEDLINE electronic databases were searched in order to identify studies with emergency or prophylactic V-A ECMO application in association with TAVI procedures. From November 2012 to November 2017, 14 relevant studies were identified that included 5,115 TAVI patients of whom 102 (2%) required V-A ECMO (22 prophylactically, 66 as an emergency and 14 without a reported indication). The reason for emergency V-A ECMO institution was detailed in 64 patients: left ventricle free wall rupture (n = 14), haemodynamic instability (n = 12), ventricular arrhythmias (n = 7), aortic annulus rupture (n = 6), coronary obstruction (n = 6), low left ventricular output (ejection fraction <35%) (n = 5), uncontrollable bleeding (n = 5), severe aortic regurgitation (n = 4), prosthesis embolisation (n = 3), aortic dissection (n = 1) and respiratory failure (n = 1). Femoral arterial and vein cannulation was the most common access technique for V-A ECMO institution. Major bleeding (n = 7) and vascular access complications (n = 7) were reported after ECMO institution. The overall in-hospital survival was 73% (61% in the emergency vs. 100% in the prophylactic group). V-A ECMO support should be available at any centre performing TAVI and provides effective mechanical circulatory support in an emergency setting. We present an algorithm to aid decisions about prophylactic circulatory assistance with V-A ECMO and it should form part of the heart team discussion before a TAVI procedure is undertaken.
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Affiliation(s)
- Giuseppe M. Raffa
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation and Department of Anaesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Mariusz Kowalewski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Poland
- Cardiothoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Paolo Meani
- Intensive Care Unit, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiology Departments, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Fabrizio Follis
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation and Department of Anaesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Gennaro Martucci
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation and Department of Anaesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Antonio Arcadipane
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation and Department of Anaesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Michele Pilato
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation and Department of Anaesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Jos Maessen
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
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20
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Mayr NP, Wiesner G, Husser O, Joner M, Michel J, Knorr J, Pellegrini C, Bleiziffer S, Schunkert H, Lange R, Tassani-Prell P. Critical adverse events during transfemoral TAVR in conscious sedation. Is an anesthesiologic support mandatory? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:41-46. [DOI: 10.1016/j.carrev.2018.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 05/28/2018] [Accepted: 06/19/2018] [Indexed: 12/20/2022]
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21
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Fabbro M, Damluji AA, Cohen MG, Epstein RH. Cardiorespiratory Stability of Patients Undergoing Transcatheter Aortic Valve Replacement Is Not Improved During General Anesthesia Compared to Sedation: A Retrospective, Observational Study. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2018. [DOI: 10.1080/24748706.2018.1438688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Michael Fabbro
- University of Miami, Miller School of Medicine, Miami, Florida, USA
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22
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Abstract
PURPOSE OF REVIEW Transcatheter valvular interventions have increased in importance and utility for surgical valve repair and replacement. Cardiac imaging is the most crucial aspect of procedural planning and guidance. Echocardiography is a widely used, portable, and dynamic imaging modality used for many of these interventions. This review will summarize the role echocardiography in structural heart valvular interventions. RECENT FINDINGS Intraprocedural echocardiographic guidance has been a mainstay of structural heart interventions. Over the years, the use of 3-dimensional echocardiography has increased, and studies have shown utility in paravalvular leak prediction in the setting of transcatheter aortic valve replacement, procedural guidance in MitraClip repair, and in mitral and tricuspid valve therapies. Intraprocedural echocardiography is of paramount important for procedural success during all structural heart valvular interventions. Continued use of 2 and 3-dimensional echocardiography will be a major factor in driving the innovative field of structural heart interventions forward.
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Affiliation(s)
- Omar K Khalique
- Columbia University Medical Center/New York Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY, 10032, USA
| | - Rebecca T Hahn
- Columbia University Medical Center/New York Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY, 10032, USA.
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