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Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
[Transcatheter aortic valve implantation – What does the anaesthetist need to know and pay attention to?]
Insights
Transcatheter aortic valve implantation (TAVI) is a key innovation for high-risk elderly patients with aortic stenosis. This minimally invasive procedure requires updated anesthetic skills due to patient comorbidities and high mortality risks.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Anesthesiology
Background:
- Increasing proportion of elderly patients with comorbidities undergoing cardiac surgery.
- Rising numbers of combined cardiac surgical procedures in this demographic.
- Significant aortic stenosis poses a high risk in elderly patients.
Purpose of the Study:
- To highlight the growing importance of transcatheter aortic valve implantation (TAVI).
- To emphasize the challenges in managing high-risk TAVI patients.
- To underscore the need for updated anesthetic management for TAVI procedures.
Main Methods:
- Review of advancements in cardiovascular surgery.
- Analysis of the increasing trend of TAVI procedures.
- Examination of patient profiles undergoing TAVI, focusing on comorbidities and risks.
Main Results:
- Transcatheter aortic valve implantation (TAVI) has seen a significant increase, reaching 10,500 procedures in Germany by 2013.
- TAVI patients are typically elderly with high-risk comorbidities, leading to elevated perioperative complication and mortality rates.
- The hybrid nature of TAVI necessitates specialized anesthetic expertise.
Conclusions:
- Transcatheter aortic valve implantation (TAVI) is a crucial treatment for high-risk elderly patients with aortic stenosis.
- Effective management of TAVI patients requires a multidisciplinary approach involving cardiology, surgery, and anesthesiology.
- Anesthetists must adapt and update their skills to ensure optimal patient care during TAVI procedures.
Abstract:
Recent advancements in the field of cardiovascular surgery have been dominated by 3 aspects that comparably challenge a sophisticated cardiological, surgical and anaesthesiological management of this patient population. The proportion of elderly patients with relevant comorbidities increases steadily, and the number of combined cardiac surgical procedures is rising in this elderly population. A very important innovation in the last decade pertaining to the treatment of elderly patients at high risk suffering from significant aortic stenosis is the minimally invasive transcatheter aortic valve implantation (TAVI). Over the last 7 years this interventional-surgical "hybrid-procedure" has increased in numbers from almost 0 to 10,500 procedures in 2013 in Germany, performed at more than 80 centers. These patients relevant comorbidities accounting for a high risk of perioperative complications and moreover for a high mortality. The combination of a patient at high risk with the specific characteristics of the TAVI procedure necessitates to update the required skills of anaesthetists responsible for providing care for this kind of procedure.
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