Transcatheter aortic valve implantation: anesthetic considerations

Area of Science:

• Cardiology
• Anesthesiology
• Interventional Cardiology

Background:

• Aortic stenosis is a common, debilitating heart valve disease.
• Surgical aortic valve replacement is not feasible for many high-risk patients.
• Transcatheter aortic valve implantation (TAVI) provides a less invasive alternative.

Purpose of the Study:

• To review the anesthesiologist's role in TAVI.
• To focus on anesthetic management, intraoperative events, TEE, and complications.
• To highlight challenges of transfemoral and transapical TAVI approaches.

Main Methods:

• Literature review and clinical experience analysis.
• Focus on anesthetic care, hemodynamic manipulation, and transesophageal echocardiography (TEE).
• Discussion of transfemoral retrograde and transapical antegrade TAVI techniques.

Main Results:

• TAVI requires general anesthesia, hemodynamic management, and TEE.
• Key maneuvers include rapid ventricular pacing and mechanical ventilation cessation.
• Potential complications include hypotension, arrhythmias, regurgitation, and stroke.

Conclusions:

• TAVI success depends on intraoperative hemodynamic management.
• Both transfemoral and transapical TAVI approaches present unique challenges.
• Anesthesiologists are essential in managing debilitated patients undergoing TAVI.