Transcatheter implantation of an aortic valve: anesthesiological management

Aortic stenosis (AS) is the most common form of valvular disease in adults. This condition also causes significant morbidity and mortality, especially among the elderly. Recent progress in balloon and stent technologies has offered the potential to transform the management of aortic stenosis. Transcatheter aortic valve implantation (TAVI) represents a new technique for the treatment of AS. Two devices are currently available for TAVI, which are the Edwards-Sapien valve and the CoreValve Revalving System. The goals of hemodynamic management during this procedure are the same as those performed during surgical aortic valve replacement. Namely, hemodynamic stability is the main goal of anesthesiological management during TAVI. The reduced invasivity of the TAVI approach demands careful monitoring of cardiovascular function because of the increased comorbidity associated with these patients. Furthermore, because of their carotid, aortic, valvular, coronary and peripheral vascular diseases, patients undergoing TAVI are at risk for hemodynamic instability. Moreover, two risk models are commonly used for patient selection for TAVI: the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the Society of Thoracic Surgeon database. However, these two risk models are not entirely appropriate for the current assessments because they omit important risk factors. This bias is probably due to recent advances in intraoperative mortality and improved postoperative care. Notably, TAVI probably requires a "failing health patient" score. In our opinion, the evaluation of procedural risk should include the specific scoring of newer parameters that are not currently in use. TAVI offers a number of advantages to patients and medical teams, but there are still accompanying anesthesiological risks, and the hemodynamic periprocedural setting is an important issue for this type of procedure.