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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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2
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Yu S, Fabbro M, Aljure O. Expert Consensus Systems of Care Proposal to Optimize Care for Patients With Valvular Heart Disease Review of the 2019 Document for the Cardiac Anesthesiologist. J Cardiothorac Vasc Anesth 2020; 34:2476-2483. [PMID: 31917079 DOI: 10.1053/j.jvca.2019.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/09/2019] [Accepted: 11/28/2019] [Indexed: 11/11/2022]
Abstract
Valvular heart disease requiring intervention is increasing in prevalence in the adult population. With advancement in transcatheter and surgical procedures for valvular heart disease, optimization of patient selection, availability of resources and personnel, appropriate training and certification, and optimal periprocedural management rely on clinical evaluation, accurate echocardiographic interpretation, and understanding of valvular pathophysiology by the cardiac anesthesiologist. To optimize care and improve access for patients with valvular heart disease the Expert Consensus Systems of Care Document by Nishimura et al.1 was recently published. The authors propose a protocol with guidelines and performance metrics to create tiered-level valve centers. This review focuses and expands on aspects discussed in Nishimura et al.'s Expert Consensus Systems of Care Document that are relevant to the cardiac anesthesiologist in the periprocedural setting.
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Affiliation(s)
- Soojie Yu
- University of Miami Miller School of Medicine, Department of Anesthesiology, Miami, FL.
| | - Michael Fabbro
- University of Miami Miller School of Medicine, Department of Anesthesiology, Miami, FL
| | - Oscar Aljure
- University of Miami Miller School of Medicine, Department of Anesthesiology, Miami, FL
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3
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Elkaryoni A, Nanda NC, Baweja P, Arisha MJ, Zamir H, Elgebaly A, Altibi AM, Sharma R. Three-dimensional transesophageal echocardiography is an attractive alternative to cardiac multi-detector computed tomography for aortic annular sizing: Systematic review and meta-analysis. Echocardiography 2019; 35:1626-1634. [PMID: 30296350 DOI: 10.1111/echo.14147] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/19/2018] [Accepted: 09/10/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Cardiac imaging is the cornerstone of the pretranscatheter aortic valve replacement (TAVR) assessment. Multi-detector computed tomography (MDCT) is considered the conventional imaging modality. However, there is still no definitive gold standard. Targeted cohort of inoperable high-risk patients with underlying comorbidities, particularly renal impairment, makes apparent the need for MDCT alternative. We aimed to demonstrate the correlation extent between MDCT and three-dimensional transesophageal echocardiography (3DTEE) aortic annular area measures and to answer the question: Is 3DTEE a good alternative to MDCT? METHODS A systematic literature search and meta-analysis were conducted to evaluate the degree of correlation and agreement between 3DTEE and MDCT aortic annular sizing. A thorough assessment of EMBASE, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL) was performed. All studies comparing 3DTEE and MDCT in relation to aortic annular sizing were included. RESULTS Thirteen studies were included (N = 1228 patients). A strong linear correlation was found between 3DTEE and MDCT measurements of aortic annulus area (r = 0.84, P < 0.001), mean perimeter (r = 0. 0.85, P < 0.001), and mean diameter (r = 0.80, P < 0.001). Bland-Altman plots revealed smaller mean 3DTEE values in comparison to MDCT for aortic annular area, the mean difference being -2.22 mm2 with 95% limits of agreement -12.79 to 8.36. CONCLUSION Aortic annulus measurements obtained by 3DTEE demonstrated a high level of correlation with those evaluated by MDCT. This makes 3DTEE a feasible choice for aortic annulus assessment, with advantage of real time assessment, lack of contrast, and no radiation exposure.
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Affiliation(s)
- Ahmed Elkaryoni
- Division of Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri
| | - Navin C Nanda
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Paramdeep Baweja
- Division of Cardiovascular Disease, University of Missouri Kansas City, Kansas City, Missouri
| | - Mohammed J Arisha
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Harris Zamir
- Division of Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri
| | | | - Ahmed Ma Altibi
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rishi Sharma
- Division of Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri
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4
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Patel PA, Ackermann AM, Augoustides JG, Ender J, Gutsche JT, Giri J, Vallabhajosyula P, Desai ND, Kostibas M, Brady MB, Eoh EJ, Gaca JG, Thompson A, Fitzsimons MG. Anesthetic Evolution in Transcatheter Aortic Valve Replacement: Expert Perspectives From High-Volume Academic Centers in Europe and the United States. J Cardiothorac Vasc Anesth 2017; 31:777-790. [DOI: 10.1053/j.jvca.2017.02.051] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Indexed: 11/11/2022]
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Zakhary WZA, Turton EW, Ender JK. Post-operative patient care and hospital implications of fast track. Eur Heart J Suppl 2017. [DOI: 10.1093/eurheartj/suw055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Ramakrishna H, Gutsche JT, Patel PA, Evans AS, Weiner M, Morozowich ST, Gordon EK, Riha H, Bracker J, Ghadimi K, Murphy S, Spitz W, MacKay E, Cios TJ, Malhotra AK, Baron E, Shaefi S, Fassl J, Weiss SJ, Silvay G, Augoustides JGT. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2016. J Cardiothorac Vasc Anesth 2016; 31:1-13. [PMID: 28041810 DOI: 10.1053/j.jvca.2016.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Indexed: 12/11/2022]
Affiliation(s)
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Adam S Evans
- Department of Anesthesiology, Cleveland Clinic Florida, Weston, FL
| | - Menachem Weiner
- Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | | | - Emily K Gordon
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hynek Riha
- Cardiothoracic Anesthesiology and Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Joseph Bracker
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kamrouz Ghadimi
- Cardiothoracic Anesthesiology, Department of Anesthesiology and Critical Care, Duke University, Durham, NC
| | - Sunberri Murphy
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Warren Spitz
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Emily MacKay
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | - Elvera Baron
- Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - Shahzad Shaefi
- Cardiothoracic Anesthesiology and Critical Care, Department of Anesthesiology, Harvard Medical School, Boston, MA
| | - Jens Fassl
- Cardiovascular and Thoracic Section, Department of Anesthesia and Intensive Care Medicine, University of Basel, Basel, Switzerland
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - George Silvay
- Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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7
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Fernando R, Gutsche JT, Augoustides JGT, Kukafka JD, Spitz W, Frogel J, Fabbro M, Patel PA. Transcatheter Aortic Valve Replacement After Intraoperative Discovery of Porcelain Aorta in a Patient With Aortic Stenosis. J Cardiothorac Vasc Anesth 2016; 31:738-747. [PMID: 27543996 DOI: 10.1053/j.jvca.2016.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Rohesh Fernando
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Jeremy D Kukafka
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Warren Spitz
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jonathan Frogel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael Fabbro
- Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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8
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Carvajal T, Villablanca-Spinetto P, Augoustides JGT, Morozowich ST, Shamoum FE, Gutsche JT, Ramakrishna H. Transcatheter Aortic Valve Replacement: Recent Evidence from Pivotal Trials. J Cardiothorac Vasc Anesth 2016; 30:831-40. [PMID: 27021178 DOI: 10.1053/j.jvca.2015.12.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Tomas Carvajal
- Department of Anesthesiology, Mayo Clinic, Scottsdale, AZ
| | - Pedro Villablanca-Spinetto
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY
| | - John G T Augoustides
- Cardiovascular and Thoracic Division, Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;.
| | - Steven T Morozowich
- Division of Cardiothoracic and Vascular Anesthesiology, Department of Anesthesiology, Mayo Clinic, Scottsdale, AZ
| | - Fadi E Shamoum
- Division of Cardiovascular Diseases and Vascular Medicine, Department of Medicine, Mayo Clinic, Scottsdale, AZ
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Division, Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Harish Ramakrishna
- Division of Cardiothoracic and Vascular Anesthesiology, Department of Anesthesiology, Mayo Clinic, Scottsdale, AZ
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9
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Ramakrishna H, Patel PA, Gutsche JT, Vallabhajosyula P, Spitz W, Feinman JW, Shah R, Zhou E, Weiss SJ, Augoustides JG. Transcatheter Aortic Valve Replacement: Clinical Update on Access Approaches in the Contemporary Era. J Cardiothorac Vasc Anesth 2016; 30:1425-9. [PMID: 27468895 DOI: 10.1053/j.jvca.2016.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Phoenix, Arizona
| | | | | | - Prashanth Vallabhajosyula
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | - Ronak Shah
- Department of Anesthesiology and Critical Care
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10
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Anaesthetic management of percutaneous aortic valve implants: Results of 100 cases. ACTA ACUST UNITED AC 2016; 63:451-8. [PMID: 26907801 DOI: 10.1016/j.redar.2016.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 01/10/2016] [Accepted: 01/11/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Transfemoral transcatheter aortic-valve implantation represents a therapeutic alternative for patients with severe aortic stenosis who cannot undergo surgery due to high surgical risk. OBJECTIVE The aim of this study is to describe the anaesthetic procedure for transfemoral transcatheter aortic-valve implantation and the results on 100 patients with symptomatic severe aortic stenosis. MATERIAL AND METHODS A series of cases are presented with prospective data collected on 100 consecutive patients. The anaesthetic procedure consisted of continuous remifentanil and propofol infusions, for sedation or general anaesthetic. RESULTS Almost two-thirds (65%) of the cases ended on sedation, and 35% on general anaesthetic (19% out of this total were elective and 16% were due to complications during the procedure). Complications occurred in 34% of the cases, with both vascular and complete atrioventricular block being the most frequent. Mortality within the first 24h was 5%. CONCLUSIONS Implantation of transfemoral aortic prosthesis under remifentanil-propofol sedation can be considered a valid therapeutic alternative for patients with severe symptomatic aortic stenosis, and with a high surgical risk, and therefore not considered for conventional surgery.
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11
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Sedation or general anesthesia for patients undergoing transcatheter aortic valve implantation—does it affect outcome? An observational single-center study. J Clin Anesth 2015; 27:385-90. [DOI: 10.1016/j.jclinane.2015.03.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 09/10/2014] [Accepted: 03/26/2015] [Indexed: 11/23/2022]
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12
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Fabbro M, Goldhammer J, Augoustides JGT, Patel PA, Frogel J, Ianchulev S, Cobey FC. CASE 1-2016 Problem-Solving in Transcatheter Aortic Valve Replacement: Cardiovascular Collapse, Myocardial Stunning, and Mitral Regurgitation. J Cardiothorac Vasc Anesth 2015; 30:229-36. [PMID: 26119409 DOI: 10.1053/j.jvca.2015.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Michael Fabbro
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jordan Goldhammer
- Cardiothoracic and Vascular Section, Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathan Frogel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stefan Ianchulev
- Cardiac Section, Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts
| | - Frederic C Cobey
- Cardiac Section, Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts
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13
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Zhu H, Kothandan H, Saw EKM, Shitalkumar S. Direct Aortic Transcatheter Aortic Valve Implantation: Anaesthesia Attentions. PROCEEDINGS OF SINGAPORE HEALTHCARE 2015. [DOI: 10.1177/201010581502400109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Surgical replacement of aortic valve is the gold standard therapy for severe aortic valve stenosis. Transcatheter Aortic Valve Implantation (TAVI) is less invasive and becomes an alternative therapy reserved for patients with high operative risk. TAVI can be performed via transfemoral, transapical or transaortic approach. Patients with diseased or difficult femoral/iliac vascular access, poor left ventricular function and significant respiratory disease are not suitable for transfemoral or transapical approach. In this scenario, direct transaortic approach of TAVI is a feasible option. This case report presents a case of a 76-year-old man with symptomatic severe aortic valve stenosis who underwent general anaesthesia and was successfully treated by direct transaortic TAVI using Edwards Sapien XT aortic bioprosthesis.
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Affiliation(s)
- Haibei Zhu
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | | | - Eddy Kah Ming Saw
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Shah Shitalkumar
- Department of Cardiothoracic Anaesthesia, National Heart Centre Singapore, Singapore
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14
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Gutsche JT, Patel PA, Walsh EK, Sophocles A, Chern SYS, Jones DB, Anwaruddin S, Desai ND, Weiss SJ, Augoustides JGT. New frontiers in aortic therapy: focus on current trials and devices in transcatheter aortic valve replacement. J Cardiothorac Vasc Anesth 2015; 29:536-41. [PMID: 25572322 DOI: 10.1053/j.jvca.2014.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Indexed: 12/11/2022]
Abstract
The first decade of clinical experience with transcatheter aortic valve replacement since 2002 saw the development of 2 main valve systems, namely the Edwards Sapien balloon-expandable valve series and the Medtronic self-expanding CoreValve. These 2 valve platforms now have achieved commercial approval and application worldwide in patients with severe aortic stenosis whose perioperative risk for surgical intervention is high or extreme. In the second decade of transcatheter aortic valve replacement, clinical experience and refinements in valve design have resulted in clinical drift towards lower patient risk cohorts. There are currently 2 major trials, PARTNER II and SURTAVI, that are both evaluating the role of transcatheter aortic valve replacement in intermediate-risk patient cohorts. The results from these landmark trials may usher in a new clinical paradigm for transcatheter aortic valve replacement in its second decade.
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Affiliation(s)
| | | | | | | | | | | | - Saif Anwaruddin
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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15
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Patel PA, Gutsche JT, Vernick WJ, Giri JS, Ghadimi K, Weiss SJ, Jagasia DH, Bavaria JE, Augoustides JGT. The functional aortic annulus in the 3D era: focus on transcatheter aortic valve replacement for the perioperative echocardiographer. J Cardiothorac Vasc Anesth 2014; 29:240-5. [PMID: 25620147 DOI: 10.1053/j.jvca.2014.05.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Indexed: 02/08/2023]
Abstract
The functional aortic annulus represents a sound clinical framework for understanding the components of the aortic root complex. Recent three-dimensional imaging analysis has demonstrated that the aortic annulus frequently is elliptical rather than circular. Comprehensive three-dimensional quantification of this aortic annular geometry by transesophageal echocardiography and/or multidetector computed tomography is essential to guide precise prosthesis sizing in transcatheter aortic valve replacement to minimize paravalvular leak for optimal clinical outcome. Furthermore, three-dimensional transesophageal echocardiography accurately can quantify additional parameters of the functional aortic annulus such as coronary height for complete sizing profiles for all valve types in transcatheter aortic valve replacement. Although it is maturing rapidly as a clinical imaging modality, its role in transcatheter aortic valve replacement is seen best as complementary to multidetector computed tomography in a multidisciplinary heart team model.
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Affiliation(s)
- Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - William J Vernick
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jay S Giri
- Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PA
| | - Kamrouz Ghadimi
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Dinesh H Jagasia
- Cardiovascular Imaging, Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PA
| | - Joseph E Bavaria
- Thoracic Aortic Program, Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PA
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Oguri A, Yamamoto M, Mouillet G, Gilard M, Laskar M, Eltchaninoff H, Fajadet J, Iung B, Donzeau-Gouge P, Leprince P, Leguerrier A, Prat A, Lievre M, Chevreul K, Dubois-Rande JL, Chopard R, Van Belle E, Otsuka T, Teiger E. Clinical Outcomes and Safety of Transfemoral Aortic Valve Implantation Under General Versus Local Anesthesia. Circ Cardiovasc Interv 2014; 7:602-10. [DOI: 10.1161/circinterventions.113.000403] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Atsushi Oguri
- From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital,
| | - Masanori Yamamoto
- From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital,
| | - Gauthier Mouillet
- From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital,
| | - Martine Gilard
- From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital,
| | - Marc Laskar
- From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital,
| | - Helene Eltchaninoff
- From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital,
| | - Jean Fajadet
- From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital,
| | - Bernard Iung
- From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital,
| | - Patrick Donzeau-Gouge
- From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital,
| | - Pascal Leprince
- From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital,
| | - Alain Leguerrier
- From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital,
| | - Alain Prat
- From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital,
| | - Michel Lievre
- From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital,
| | - Karine Chevreul
- From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital,
| | - Jean-Luc Dubois-Rande
- From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital,
| | - Romain Chopard
- From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital,
| | - Eric Van Belle
- From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital,
| | - Toshiaki Otsuka
- From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital,
| | - Emmanuel Teiger
- From the Centre Hospitalier Universitaire (CHU) Henri Mondor, Creteil, France (A.O., M.Y., G.M., K.C., J.-L.D.-R., E.T.); Centre Hospitalier Universitaire Brest, Brest, France (M.G.); Centre Hospitalier Universitaire Dupuytren, Limoges, France (M. Laskar); Hopital Charles Nicolle, University of Rouen, INSERM Unite 1096, Rouen, France (H.E.); Clinique Pasteur, Toulouse, France (J.F.); Bichat Hospital, Paris, France (B.I.); Insitut Jacques Cartier, Massy, France (P.D.-G.); Pitie-Salpetriere Hospital,
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Tagarakis GL, Whitlock RP, Gutsche JT, Diegeler A, Patel PA, Daskalopoulos ME, Vernick WJ, Anastasiadis K, Augoustides JG. New frontiers in aortic therapy: focus on deliberate hypotension during thoracic aortic endovascular interventions. J Cardiothorac Vasc Anesth 2014; 28:843-7. [PMID: 24746338 DOI: 10.1053/j.jvca.2014.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Georgios L Tagarakis
- Department of Surgery, AHEPA Hospital, Aristotle University, Thessaloniki, Greece
| | | | - Jacob T Gutsche
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Prakash A Patel
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - William J Vernick
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - John G Augoustides
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Ramakrishna H, Kohl BA, Jassar AS, Augoustides JGT. Incidental moderate mitral regurgitation in patients undergoing aortic valve replacement for aortic stenosis: review of guidelines and current evidence. J Cardiothorac Vasc Anesth 2014; 28:417-22. [PMID: 24508019 DOI: 10.1053/j.jvca.2013.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Indexed: 11/11/2022]
Abstract
Recent evidence has shown that moderate mitral regurgitation is common and clinically relevant in patients presenting for surgical and transcatheter aortic valve replacement for aortic stenosis. Prospective multicenter clinical trials are now indicated to resolve the clinical equipoise about whether or not mitral valve intervention also is indicated at the time of aortic valve intervention. Advances in three-dimensional transesophageal echocardiography, transcatheter mitral interventions, and surgical aortic valve replacement, including the advent of sutureless valves, likely will expand the therapeutic possibilities for moderate mitral regurgitation in the setting of aortic valve interventions for severe aortic stenosis.
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Affiliation(s)
| | - Benjamin A Kohl
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Arminder S Jassar
- Department of Surgery, Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G T Augoustides
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Ghadimi K, Patel PA, Gutsche JT, Sophocles A, Anwaruddin S, Szeto WY, Augoustides JG. Perioperative Conduction Disturbances After Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2013; 27:1414-20. [DOI: 10.1053/j.jvca.2013.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Indexed: 11/11/2022]
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Ramakrishna H, Reidy C, Riha H, Sophocles A, Lane BJ, Patel PA, Andritsos M, Ghadimi K, Augoustides JGT. The year in cardiothoracic and vascular anesthesia: selected highlights from 2012. J Cardiothorac Vasc Anesth 2013; 27:86-91. [PMID: 23312777 DOI: 10.1053/j.jvca.2012.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Indexed: 11/11/2022]
Abstract
Cardiothoracic and vascular critical care has emerged as a subspecialty due to procedural breakthroughs, an aging population, and a multidisciplinary collaboration. This subspecialty now has a dedicated professional society, recently published guidelines, and plans for standardized certification. This paradigm shift represents a major collaboration opportunity for our specialty. The rise of evidence-based perioperative practice has produced a culture of large trials in our specialty to search for solutions to the challenging outcome questions. Besides the growth in the development of evidence, the consensus conference format and postpublication peer review have both emerged as effective processes for identifying the most relevant high-quality evidence. The quest for best perioperative practice has highlighted the importance of teamwork at all phases of care with respect to transitions in care, blood component transfusion, and research misconduct. The emergence of ultrasound as a standard for central vascular access also has been emphasized in recent multisociety guidelines. There also has been a paradigm shift in the management of patients with coronary artery disease. Recent guidelines have emphasized the roles of the cardiac anesthesiologist and the interventional cardiologist as part of the heart team approach. Major recent trials in comparative effectiveness have challenged the advantages of percutaneous coronary intervention, off-pump coronary artery bypass surgery, and intra-aortic balloon counterpulsation. The year 2012 has witnessed the emergence of new paradigms of care in our specialty with the emphasis on teamwork, safety, and quality. These processes will further improve perioperative outcome.
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Sfeir PM, Abchee AB, Ghazzal Z, Beresian J, Gellad P, Ayoub CM. Endovascular Transcatheter Aortic Valve Implantation: An Evolving Standard. J Cardiothorac Vasc Anesth 2013; 27:765-78. [DOI: 10.1053/j.jvca.2012.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Indexed: 11/11/2022]
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Fernández Suárez FE, del Valle Fernández R, González Alvarez A, Sánchez Lasheras J, Fernández Sánchez L, Argüelles Tamargo L. [Anesthetic management and experience in the transcatheter implantation of the CoreValve(®) self-expanding aortic valve]. ACTA ACUST UNITED AC 2013; 60:440-7. [PMID: 23829945 DOI: 10.1016/j.redar.2013.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/30/2013] [Accepted: 05/07/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze the experience and anesthetic management in the transcatheter implantation of the CoreValve(®) self-expanding aortic valve, in a university tertiary hospital. MATERIAL AND METHODS Observational analytical review of data incorporated into a prospectively maintained database of 142 patients diagnosed with severe aortic stenosis who underwent implantation of a CoreValve(®) aortic self-expanding aortic valve between December 2007 and December 2012. RESULTS The mean age of patients was 82.5±6.1 years and the logistic EuroSCORE was 14.9±11.2. General anesthesia was used in 107 patients (75.3%), with local anesthesia with sedation in 35 (24.6%). Local anesthesia and sedation was associated with a lower requirement of vasoactive drugs (P=.003) during implantation. No statistically significant differences were found between the 2 anesthetic techniques in the duration of the procedure, hospital stay, or morbimortality. The success rate was 97.1%. The most common complication was conduction disorders that required implantation of a permanent pacemaker in 46 patients (32.3%). There was no intraoperative mortality, and all-cause mortality at 30 days was 6.3%, with a one-year survival estimated by the Kaplan-Meier of 83.1%. CONCLUSIONS This study confirms that in patients with severe aortic stenosis and high surgical risk, transcatheter implantation of aortic valve is a safe and effective alternative. Both, general anesthesia and local anesthesia with sedation are valid options, depending on the experience of the team.
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Affiliation(s)
- F E Fernández Suárez
- Servicio de Anestesiología y Reanimación, Hospital Central de Asturias, Oviedo, España.
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Grando TA, Sarmento-Leite R, Lunardi Prates PR, Gomes CR, Specht F, Gheller AS, Bernardi G. Anesthetic management and complications of percutaneous aortic valve implantation. Rev Bras Anestesiol 2013; 63:279-86. [PMID: 23683452 DOI: 10.1016/s0034-7094(13)70231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 08/20/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Aortic stenosis is a highly prevalent and life-threatening disease. In elderly patients with comorbidities, percutaneous valve implantation is an option. The aim of the study was to describe the anesthetic management and complications of general anesthesia. METHOD Case series with 30-day and 24-month follow-ups after implantation of the CoreValve device performed at the Institute of Cardiology/University Foundation of Cardiology between December 2008 and January 2012. The patients underwent general anesthesia monitored with mean arterial pressure (PAM), electrocardiogram (ECG), pulse oximetry, capnography, transesophageal echocardiography, thermometry, and transvenous pacemaker. RESULTS Twenty-eight patients, mean age 82.46 years, 20.98% mean EuroSCORE, functional class III/IV, successfully underwent valve implantation. Nine patients required permanent pacemaker implantation. During follow-up, two patients died: one during surgery due to LV perforation and the other on the third day of unknown causes. At 24 months, one patient diagnosed with multiple myeloma died. This anesthetic technique proved to be safe. CONCLUSION The initial experience with percutaneous aortic valve implantation under general anesthesia has proven to be safe and effective, with no significant anesthetic complications during this procedure.
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Affiliation(s)
- Tailur Alberto Grando
- Center for Teaching and Training (CET), Society of Anesthesiology (SANE), Porto AlegreInstitute of Cardiology/Fundacao Universitaria de Cardiologia de Porto Alegre, Brazil.
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Reidy C, Sophocles A, Ramakrishna H, Ghadimi K, Patel PA, Augoustides JG. Challenges After the First Decade of Transcatheter Aortic Valve Replacement: Focus on Vascular Complications, Stroke, and Paravalvular Leak. J Cardiothorac Vasc Anesth 2013; 27:184-9. [DOI: 10.1053/j.jvca.2012.09.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Indexed: 02/06/2023]
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Candela-Toha AM, Martínez-Borja M. [Transcatheter aortic valve prostheses: an open future]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2012; 59:530-534. [PMID: 22840356 DOI: 10.1016/j.redar.2012.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 06/17/2012] [Indexed: 06/01/2023]
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Patel PA, Ramakrishna H, Andritsos M, Wyckoff T, Riha H, Augoustides JGT. The year in Cardiothoracic and Vascular Anesthesia: selected highlights from 2011. J Cardiothorac Vasc Anesth 2012; 26:3-10. [PMID: 22221506 DOI: 10.1053/j.jvca.2011.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Indexed: 11/11/2022]
Abstract
There have been rapid advances in oral anticoagulation. The oral factor Xa inhibitors rivaroxaban and apixaban and the oral direct thrombin inhibitor dabigatran recently have been rigorously evaluated. These novel anticoagulants will usher in a new paradigm for perioperative anticoagulation. Perioperative blood conservation in cardiac surgery recently has been highlighted in the updated guidelines by the Society of Cardiovascular Anesthesiologists and the Society of Thoracic Surgeons. These recommendations reflect a comprehensive evaluation of the recent evidence to optimize transfusion practice. Transcatheter mitral valve repair continues to mature. Transcatheter aortic valve implantation for aortic stenosis has entered the clinical mainstream, with randomized trials showing its superiority over medical management and its equivalency to surgical valve replacement in high-risk patients. This transformational technology represents a major leadership opportunity for the cardiac anesthesiologist. Minimally invasive valve surgery has shown effectiveness in high-risk patients. Radial access is equivalent to femoral access for percutaneous coronary intervention in acute coronary syndromes but significantly reduces the risk of local vascular complications. Recent trials have further clarified the roles of medical therapy, percutaneous coronary intervention, and coronary artery bypass surgery in patients with significant coronary artery disease and left ventricular dysfunction. The past year has witnessed major advances in cardiovascular practice with new drugs, new devices, and new guidelines. The coming year most likely will advance these achievements to enhance the care of patients.
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Affiliation(s)
- Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Patel PA, Fassl J, Thompson A, Augoustides JGT. Transcatheter aortic valve replacement--part 3: the central role of perioperative transesophageal echocardiography. J Cardiothorac Vasc Anesth 2012; 26:698-710. [PMID: 22578977 DOI: 10.1053/j.jvca.2012.03.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Prakash A Patel
- Cardiothoracic and Vascular Section, Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA
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Abstract
Surgical replacement of aortic valves is the gold standard for therapy of high grade aortic valve stenosis. However, the changes in demography confront the responsible medical discipline with an increasingly higher risk profile of patients which necessitates the development of new less invasive alternative forms of treatment for the surgical therapy of aortic valve stenosis. This developmental process has progressed from mini-thoracotomy to transcatheter aortic valve implantation (TAVI). The TAVI procedure is a new therapeutic option for treatment of patients with high grade aortic valve stenosis and high perioperative morbidity and mortality risks with conventional aortic valve replacement. Because TAVI can be carried out while the heart is still beating and without a sternotomy or heart-lung maschine, this procedure is particularly suitable for elderly multimorbid patients and/or patients with previous cardiac surgery. The initial results of large prospective multicenter studies underline the value of TAVI in the modern treatment of high risk patients with symptomatic aortic valve stenosis. In addition to an understanding of the surgical procedure, anesthetists must have precise knowledge of the perioperative anesthesia management and possible complications of the procedure.
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Odonkor P, Stansbury LG, Gammie JS, Rock P, Fitzpatrick M, Grigore AM. Anesthetic Management of Patients Undergoing Aortic Valve Bypass (Apicoaortic Conduit) Surgery. J Cardiothorac Vasc Anesth 2012; 26:148-60. [DOI: 10.1053/j.jvca.2011.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Indexed: 11/11/2022]
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Hayman M, Forrest P, Kam P. Anesthesia for Interventional Cardiology. J Cardiothorac Vasc Anesth 2012; 26:134-47. [DOI: 10.1053/j.jvca.2011.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Indexed: 01/17/2023]
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Current World Literature. Curr Opin Anaesthesiol 2011; 24:463-5. [DOI: 10.1097/aco.0b013e3283499d5a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Andritsos M, Singh N, Patel P, Sinha A, Fassl J, Wyckoff T, Riha H, Roscher C, Subramaniam B, Ramakrishna H, Augoustides JG. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2010. J Cardiothorac Vasc Anesth 2011; 25:6-15. [DOI: 10.1053/j.jvca.2010.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Indexed: 12/14/2022]
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Du Preez LJ, Le Roux P, Coetzee AR. Anaesthesia for transvenous transcatheter tricuspid valve-in-valve implantation. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2011. [DOI: 10.1080/22201173.2011.10872794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- LJ Du Preez
- Department of Anaesthesiology and Critical Care, Tygerberg Academic Hospital and Stellenbosch University, Parow
| | - P Le Roux
- Department of Anaesthesiology and Critical Care, Tygerberg Academic Hospital and Stellenbosch University, Parow
| | - AR Coetzee
- Department of Anaesthesiology and Critical Care, Tygerberg Academic Hospital and Stellenbosch University, Parow
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Anastasiadis K, Argiriadou H, Antonitsis P, Westaby S, Papakonstantinou C, Khayat A. Use of rapid ventricular pacing for facilitating left ventricular assist device implantation. J Cardiothorac Vasc Anesth 2010; 25:598-600. [PMID: 21109460 DOI: 10.1053/j.jvca.2010.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Indexed: 11/11/2022]
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