https://scholars.lib.ntu.edu.tw/handle/123456789/595828
Title: | Transcatheter aortic valve implantation: Anesthetic experience of retrograde transfemoral approach with CoreValve ReValving System | Authors: | WEI-HAN CHOU YI-CHIA WANG HSING-HAO HUANG HSIAO-LIANG CHENG Lin, Yi-Shiuan MING-JIUH WANG CHI-HSIANG HUANG |
Issue Date: | 2014 | Publisher: | Elsevier Taiwan LLC | Journal Volume: | 52 | Journal Issue: | 1 | Start page/Pages: | 2-5 | Source: | Acta Anaesthesiologica Taiwanica | Abstract: | Objectives Valvular aortic stenosis (AS) is a major cardiac valvular disease in geriatric people. Conventional treatment for severe AS is aortic valve replacement through surgery. However, many geriatric patients are considered inoperable due to higher risks for surgery and anesthesia. Transcatheter aortic valve implantation (TAVI), a less invasive procedure, has rapidly developed in recent years as an alternative management option for high-risk AS patients. Herein, we describe our anesthetic experience in the TAVI procedure. Methods We included 11 patients who consecutively received transfemoral TAVI in the period from September 2010 to January 2011. All patients received general anesthesia with endotracheal intubation; arterial line placement and central venous catheter insertion were carried out for monitoring hemodynamics. Transesophageal echocardiography was applied for valve evaluation, hemodynamic monitoring, and intraoperative guidance. Patients were transferred to the intensive care unit for further care after surgery. The periprocedural events were recorded. Results The mean age of these patients was 82 years. Morphology of the aortic valve in all patients was tricuspid, and the etiology of AS was degenerative calcification. During TAVI, all patients received bolus injections of 5-10 μg norepinephrine just before the rapid pacing stage in order to increase the mean arterial pressure. Only one patient needed continuous infusion of dopamine because of severe preoperative congestive heart failure, and another patient needed continuous infusion of norepinephrine due to relatively old age and suspected low systemic vascular resistance. After TAVI, all patients had the endotracheal tube extubated within 7 hours, except one because of preoperative ventilator dependence. Another male patient stayed in the intensive care unit for 8 days due to postoperative complete atrioventricular block, and he received permanent pacemaker implantation. There was no early mortality. Conclusion TAVI is another choice for AS patients who have a high perioperative risk. General anesthesia with endotracheal intubation and application of transesophageal echocardiography can facilitate the use of this new technique by cardiologists. Complete preprocedural evaluation and good intraprocedural cooperation are still the gold standards to achieve successful TAVI and patient safety. ? 2014, Taiwan Society of Anesthesiologists. Published by Elsevier Taiwan LLC. All rights reserved. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-84904069678&doi=10.1016%2fj.aat.2014.05.002&partnerID=40&md5=ec2c7b47d672b6d29d7cfaa37c4fccb8 https://scholars.lib.ntu.edu.tw/handle/123456789/595828 |
ISSN: | 1875-4597 | DOI: | 10.1016/j.aat.2014.05.002 | SDG/Keyword: | amiodarone; diuretic agent; dopamine; etomidate; fentanyl; noradrenalin; oxygen; rocuronium; sevoflurane; aged; angiocardiography; aorta valve regurgitation; aorta valve stenosis; aortography; aphasia; arterial line; article; artificial heart pacemaker; atrioventricular block; brain ischemia; central venous catheter; clinical article; complete heart block; congestive heart failure; continuous infusion; endotracheal intubation; endotracheal tube; EuroSCORE; extubation; female; general anesthesia; heart atrium fibrillation; heart left bundle branch block; hemodynamic monitoring; hospitalization; human; implanted heart pacemaker; intensive care unit; length of stay; lung edema; male; mean arterial pressure; mortality; New York Heart Association class; percutaneous aortic valve; postoperative complication; preoperative period; senescence; systemic vascular resistance; transcatheter aortic valve implantation; transesophageal echocardiography; transluminal valvuloplasty; transthoracic echocardiography; tricuspid valve; unconsciousness; ventilator; very elderly; Aortic Valve Stenosis; devices; femoral artery; general anesthesia; procedures; transcatheter aortic valve implantation; Aged; Aged, 80 and over; Anesthesia, General; Aortic Valve Stenosis; Echocardiography, Transesophageal; Female; Femoral Artery; Humans; Intubation, Intratracheal; Male; Transcatheter Aortic Valve Replacement |
Appears in Collections: | 醫學系 |
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