Management of the Patient for Transcatheter Aortic Valve Implantation in the Perioperative Period

• Published in: Seminars in cardiothoracic and vascular anesthesia 2012-03, Vol.16 (1), p.25-40
• Main Authors: Huffmyer, Julie, Tashjian, Jessica, Raphael, Jacob, Jaeger, J. Michael
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - etiology; Anesthesia; Animals; Aortic Valve - surgery; Aortic Valve Insufficiency - complications; Aortic Valve Stenosis - surgery; Blood Vessels - injuries; Cardiac Catheterization; Cardiac Surgical Procedures - methods; Echocardiography, Transesophageal; Heart Conduction System - physiopathology; Heart Valve Prosthesis Implantation - methods; Hemodynamics - physiology; Humans; Intraoperative Care; Minimally Invasive Surgical Procedures - methods; Pain, Postoperative - therapy; Perioperative Care; Perioperative Period; Postoperative Care; Postoperative Complications - therapy; Preoperative Care; Treatment Outcome
• ISSN: 1089-2532; 1940-5596
• DOI: 10.1177/1089253211434966

Aortic stenosis is a prevalent valvular disease among aging patients, and surgical correction is the most definitive treatment. Yet many elderly patients are deemed to be “inoperable” or at excessive risk to undergo open surgical aortic valve replacement (AVR). Transcatheter aortic valve implantation (TAVI), either through a transfemoral or transapical approach, has become a potential option for these high-risk patients. Although TAVI technology will continue to be developed and perfected, most studies at this time reveal that symptoms are improved and that 1-year morbidity and mortality are similar to those for open surgical AVR. Anesthetic management for patients undergoing TAVI involves maintaining hemodynamic stability during periods of rapidly changing conditions and providing echocardiographic guidance and assessment. Postoperative care includes a variety of challenges such as managing pain control, monitoring for potential complications, and providing hemodynamic management.