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Anesthesiologic Management of Patients Undergoing Cardiac Transapical Procedures: Which Challenges in the Modern Era?

Marina Pieri1, Monica De Luca1, Chiara Gerli1

  • 1Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.

Journal of Cardiothoracic and Vascular Anesthesia
|December 25, 2018
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) and other transapical cardiac procedures involve high-risk patients. A tailored anesthetic approach, guided by a multidisciplinary heart team, is essential for improving outcomes in these complex cardiac surgeries.

Area of Science:

  • Cardiovascular Surgery
  • Anesthesiology
  • Cardiac Anesthesia

Background:

  • Transapical cardiac procedures are less common than traditional open-heart surgeries.
  • Patients undergoing transapical procedures are typically older with more comorbidities, posing anesthetic challenges.

Purpose of the Study:

  • To describe the anesthetic experience with transapical procedures at a high-volume center.
  • To identify critical aspects of anesthetic management for transapical cardiac interventions.

Main Methods:

  • Retrospective case series of 143 patients undergoing transapical procedures from 2009 to 2018.
  • Standardized perioperative anesthetic and hemodynamic management by trained cardiac anesthesiologists within a multidisciplinary heart team.

Main Results:

  • Procedures included aortic valve (57%), mitral valve (42%), and congenital defect correction.
  • Major intraoperative complications occurred in 3.5% of patients; 2% required conversion to open-heart surgery.
  • Hospital survival was high at 94%, with a median ICU stay of 1 day and hospital stay of 6 days.

Conclusions:

  • Transapical cardiac procedures involve a high-risk patient population.
  • A patient-tailored anesthetic strategy, integrated with the heart team's plan, is vital for successful outcomes.
Abstract

Keywords:
anesthesiacardiac surgerymortalityoutcometransapical procedure

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