Anesthetic management of patients undergoing transcatheter aortic valve implantation_West China Medical Journal

Authors：

ZHANG Fei , ZHENG Jianqiao ,  LIU Bin

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China;

Corresponding author：

LIU Bin, Email: liubinhx@foxmail.com

Keywords：

Transcatheter aortic valve implantation; Anesthetic management; Aortic stenosis

DOI：

10.7507/1002-0179.201605039

Video：

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Objective To explore the safety and feasibility of general anesthesia with tracheal intubation in transcatheter aortic valve implantation (TAVI), and the key points in anesthetic management. Methods Twenty-five patients with aortic stenosis treated by TAVI in West China Hospital of Sichuan University between September 2012 and June 2013 were included in this study. General anesthesia with tracheal intubation was chosen. We recorded and analyzed the hemodynamics, blood gas, oxygen saturation data before and after anesthesia induction, before surgery, during rapid ventricular pacing, before and after aortic valve implantation. Besides, the incidence of perioperative complications and 30-day mortality were also recorded. Results All the 25 patients underwent the implantation surgery successfully. Two patients had the second implantation surgery due to moderate reflux. All the subjects in this study tolerated general anesthesia well without any anesthesia-related complications. There were 19 cases of newly developed or aggravated heart blocks, 7 of permanent pace maker, 2 of perioperative hemorrhage, 2 of cerebral vascular events, and 1 death case. Conclusioins General anesthesia with tracheal intubation can be utilized safely in patients undergoing TAVI. TAVI is a challenging technique in need of precise collaborations of multi-disciplines, in which anesthetists should play more as a leader in evaluation and decision-making during the surgery.

Citation： ZHANG Fei, ZHENG Jianqiao, LIU Bin. Anesthetic management of patients undergoing transcatheter aortic valve implantation. West China Medical Journal, 2017, 32(4): 554-558. doi: 10.7507/1002-0179.201605039 Copy

1.	Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur Heart J, 2003, 24(13): 1231-1243.
2.	Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis-first human case description. Circulation, 2002, 106(24): 3006-3008.
3.	Cribier A, Eltchaninoff H, Tron C, et al. Early experience with percutaneous transcatheter implantation of heart valve prosthesis for the treatment of end-stage inoperable patients with calcific aortic stenosis. J Am Coll Cardiol, 2004, 43(4): 698-703.
4.	Webb JG, Chandavimol M, Thompson CR, et al. Percutaneous aortic valve implantation retrograde from the femoral artery. Circulation, 2006, 113(6): 842-850.
5.	Webb JG, Pasupati S, Humphries K, et al. Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis. Circulation, 2007, 116(7): 755-763.
6.	Vahanian A, Alfieri O, Al-Attar N, et al. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percu. Eur Heart J, 2008, 29(11): 1463-1470.
7.	Walther T, Falk V, Kempfert J, et al. Transapical minimally invasive aortic valve implantation; the initial 50 patients. Eur J CardioThorac Surg, 2008, 33(6): 983-988.
8.	Covello R, Landoni G, Michev I, et al. Percutaneous aortic valve implantation:the anesthesiologist perspective. HSR Proc Intensive Care Cardiovasc Anesth, 2009, 1(2): 28.
9.	Covello R, Landoni G, Michev I, et al. Anesthetic management of percutaneous aortic valve implantation: focus on challenges encountered and proposed solutions. J Cardiothorac Vasc Anesth, 2009, 23(3): 280-285.
10.	Covello RD, Landoni G, Zangrillo A. Anesthetic management of transcatheter aortic valve implantation. Curr Opin Anaesthesiol, 2011, 24(4): 417-425.
11.	Dehédin B, Guinot PG, Ibrahim H, et al. Anesthesia and perioperative management of patients who undergo transfemoral transcatheter aortic valve implantation: an observational study of generalversus local/regional anesthesia in 125 consecutive patients. J Cardiothorac Vasc Anesth, 2011, 25(6): 1036-1043.
12.	Cheung A, Ree R. Transcatheter aortic valve replacement. Anesthesiol Clin, 2008, 26(3): 465-479.
13.	Webb JG, Pasupati S, Achtem L, et al. Rapid pacing to facilitate transcatheter prosthetic heart valve implantation. Catheterization and Cardiovascular Interventions, 2006, 68(2): 199-204.
14.	Fassl J. Pro: transcatheter aortic valve implantation should be performed with general anesthesia. J Cardiothorac Vasc Anesth, 2012, 26(4): 733-735.
15.	Franco A, Gerli C, Ruggeri L, et al. Anaesthetic management of transcatheter aortic valve implantation. Ann Card Anaesth, 2012, 15(1): 54-63.
16.	Guarracino F, Landoni G. Con: transcatheter aortic valve implantation should not be performed under general anesthesia. J Cardiothorac Vasc Anesth, 2012, 26(4): 736-739.
17.	Ruggeri L, Gerli C, Franco A, et al. Anesthetic management for percutaneous aortic valve implantation:an overview of worldwide experiences. HSR Proc Intensive Care Cardiovasc Anesth, 2012, 4(1): 40.
18.	Bradic N, Husedzinovic I, Sutlic Z, et al. Anesthesiology management for the transcatheter aortic valve implantation. J Cardiothorac Surg, 2013, 8(Suppl 1): 317.
19.	Bufton KA, Augoustides JG, Cobey FC. Anesthesia for transfemoral aortic valve replacement in North America and Europe. J Cardiothorac Vasc Anesth, 2013, 27(1): 46-49.
20.	Grando TA, Sarmento-Leite R, Lunardi Prates PR, et al. Anesthetic management and complications of percutaneous aortic valve implantation. Rev Bras Anestesiol, 2013, 63(3): 279-286.
21.	See TY, Tan HL, Hwang NC. Anaesthesia for transcatheter aortic valve implantation. Trends in Anaesthesia and Critical Care, 2013, 3(6): 295-301.
22.	Conzen PF, Fischer S, Detter C, et al. Sevoflurane provides greater protection of the myocardium than propofol in patients undergoing off-pump coronary artery bypass surgery. J Am Soc Anesthesiol, 2003, 99(4): 826-833.
23.	Nader ND, Li CM, Khadra WZ, et al. Anesthetic myocardial protection with sevoflurane. J Cardiothorac Vasc Anesth, 2004, 18(3): 269-274.
24.	Symons JA, Myles PS. Myocardial protection with volatile anaesthetic agents during coronary artery bypass surgery: a meta-analysis. Br J Anaesth, 2006, 97(2): 127-136.
25.	Billings FT, Kodali SK, Shanewise JS. Transcatheter aortic valve implantation: anesthetic considerations. Anesth Analg, 2009, 108(5): 1453-1462.
26.	Guarracino F, Covello RD, Landoni GA, et al. Anesthetic management of transcatheter aortic valve implantation with transaxillary approach. J Cardiothorac Vasc Anesth, 2011, 25(3): 437-443.
27.	Edrich T, Sadovnikoff N. Anesthesia for patients with severe chronic obstructive pulmonary disease. Curr Opin Anaesthesiol, 2010, 23(1): 18-24.
28.	Masson JB, Kovac J, Schuler G, et al. Transcatheter aortic valve implantation review of the Nature, management, and avoidance of procedural complications. JACC Cardiovasc Interv, 2009, 2(9): 811-820.
29.	Cribier A, Eltchaninoff H, Tron C, et al. Early experience with percutaneous transcatheter implantation of heart valve prosthesis for the treatment of end-stage inoperable patients with calcific aortic stenosis. J Am Coll Cardiol, 2004, 43(4): 698-703.
30.	Khawaja MZ, Rajani R, Cook A, et al. Permanent pacemaker insertion after CoreValve transcatheter aortic valve implantation incidence and contributing factors (the UK CoreValve collaborative). Circulation, 2011, 123(9): U47-951.

1. Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur Heart J, 2003, 24(13): 1231-1243.
2. Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis-first human case description. Circulation, 2002, 106(24): 3006-3008.
3. Cribier A, Eltchaninoff H, Tron C, et al. Early experience with percutaneous transcatheter implantation of heart valve prosthesis for the treatment of end-stage inoperable patients with calcific aortic stenosis. J Am Coll Cardiol, 2004, 43(4): 698-703.
4. Webb JG, Chandavimol M, Thompson CR, et al. Percutaneous aortic valve implantation retrograde from the femoral artery. Circulation, 2006, 113(6): 842-850.
5. Webb JG, Pasupati S, Humphries K, et al. Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis. Circulation, 2007, 116(7): 755-763.
6. Vahanian A, Alfieri O, Al-Attar N, et al. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percu. Eur Heart J, 2008, 29(11): 1463-1470.
7. Walther T, Falk V, Kempfert J, et al. Transapical minimally invasive aortic valve implantation; the initial 50 patients. Eur J CardioThorac Surg, 2008, 33(6): 983-988.
8. Covello R, Landoni G, Michev I, et al. Percutaneous aortic valve implantation:the anesthesiologist perspective. HSR Proc Intensive Care Cardiovasc Anesth, 2009, 1(2): 28.
9. Covello R, Landoni G, Michev I, et al. Anesthetic management of percutaneous aortic valve implantation: focus on challenges encountered and proposed solutions. J Cardiothorac Vasc Anesth, 2009, 23(3): 280-285.
10. Covello RD, Landoni G, Zangrillo A. Anesthetic management of transcatheter aortic valve implantation. Curr Opin Anaesthesiol, 2011, 24(4): 417-425.
11. Dehédin B, Guinot PG, Ibrahim H, et al. Anesthesia and perioperative management of patients who undergo transfemoral transcatheter aortic valve implantation: an observational study of generalversus local/regional anesthesia in 125 consecutive patients. J Cardiothorac Vasc Anesth, 2011, 25(6): 1036-1043.
12. Cheung A, Ree R. Transcatheter aortic valve replacement. Anesthesiol Clin, 2008, 26(3): 465-479.
13. Webb JG, Pasupati S, Achtem L, et al. Rapid pacing to facilitate transcatheter prosthetic heart valve implantation. Catheterization and Cardiovascular Interventions, 2006, 68(2): 199-204.
14. Fassl J. Pro: transcatheter aortic valve implantation should be performed with general anesthesia. J Cardiothorac Vasc Anesth, 2012, 26(4): 733-735.
15. Franco A, Gerli C, Ruggeri L, et al. Anaesthetic management of transcatheter aortic valve implantation. Ann Card Anaesth, 2012, 15(1): 54-63.
16. Guarracino F, Landoni G. Con: transcatheter aortic valve implantation should not be performed under general anesthesia. J Cardiothorac Vasc Anesth, 2012, 26(4): 736-739.
17. Ruggeri L, Gerli C, Franco A, et al. Anesthetic management for percutaneous aortic valve implantation:an overview of worldwide experiences. HSR Proc Intensive Care Cardiovasc Anesth, 2012, 4(1): 40.
18. Bradic N, Husedzinovic I, Sutlic Z, et al. Anesthesiology management for the transcatheter aortic valve implantation. J Cardiothorac Surg, 2013, 8(Suppl 1): 317.
19. Bufton KA, Augoustides JG, Cobey FC. Anesthesia for transfemoral aortic valve replacement in North America and Europe. J Cardiothorac Vasc Anesth, 2013, 27(1): 46-49.
20. Grando TA, Sarmento-Leite R, Lunardi Prates PR, et al. Anesthetic management and complications of percutaneous aortic valve implantation. Rev Bras Anestesiol, 2013, 63(3): 279-286.
21. See TY, Tan HL, Hwang NC. Anaesthesia for transcatheter aortic valve implantation. Trends in Anaesthesia and Critical Care, 2013, 3(6): 295-301.
22. Conzen PF, Fischer S, Detter C, et al. Sevoflurane provides greater protection of the myocardium than propofol in patients undergoing off-pump coronary artery bypass surgery. J Am Soc Anesthesiol, 2003, 99(4): 826-833.
23. Nader ND, Li CM, Khadra WZ, et al. Anesthetic myocardial protection with sevoflurane. J Cardiothorac Vasc Anesth, 2004, 18(3): 269-274.
24. Symons JA, Myles PS. Myocardial protection with volatile anaesthetic agents during coronary artery bypass surgery: a meta-analysis. Br J Anaesth, 2006, 97(2): 127-136.
25. Billings FT, Kodali SK, Shanewise JS. Transcatheter aortic valve implantation: anesthetic considerations. Anesth Analg, 2009, 108(5): 1453-1462.
26. Guarracino F, Covello RD, Landoni GA, et al. Anesthetic management of transcatheter aortic valve implantation with transaxillary approach. J Cardiothorac Vasc Anesth, 2011, 25(3): 437-443.
27. Edrich T, Sadovnikoff N. Anesthesia for patients with severe chronic obstructive pulmonary disease. Curr Opin Anaesthesiol, 2010, 23(1): 18-24.
28. Masson JB, Kovac J, Schuler G, et al. Transcatheter aortic valve implantation review of the Nature, management, and avoidance of procedural complications. JACC Cardiovasc Interv, 2009, 2(9): 811-820.
29. Cribier A, Eltchaninoff H, Tron C, et al. Early experience with percutaneous transcatheter implantation of heart valve prosthesis for the treatment of end-stage inoperable patients with calcific aortic stenosis. J Am Coll Cardiol, 2004, 43(4): 698-703.
30. Khawaja MZ, Rajani R, Cook A, et al. Permanent pacemaker insertion after CoreValve transcatheter aortic valve implantation incidence and contributing factors (the UK CoreValve collaborative). Circulation, 2011, 123(9): U47-951.

West China Medical Journal

Anesthetic management of patients undergoing transcatheter aortic valve implantation

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