Anaesthesia for transcatheter aortic valve implantation (TAVI): An anaesthetist’s perspective

Q: What is the clinical evidence from this study?

Study design: Review. Population: Severe aortic stenosis (n=70). Intervention: Transcatheter aortic valve implantation (TAVI) anaesthesia management. Primary outcome: Procedural mortality.

Q: What does this research mean for the field?

Anaesthetic management for high-risk severe aortic stenosis patients undergoing transcatheter aortic valve implantation (TAVI) requires focused preoperative assessment, hemodynamic control, anticoagulation management, and vigilance for procedural complications. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Rocco Vivier

doi:10.24170/9-1-1869

April 4, 2017SA HeartOpen Access

Anaesthesia for transcatheter aortic valve implantation (TAVI): An anaesthetist’s perspective

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Why the study?

Anaesthesia management for TAVI requires specific considerations due to the high-risk profile of patients with severe aortic stenosis undergoing this procedure.

Key Points

To review the anaesthetic considerations, procedural management, and clinical outcomes during transcatheter aortic valve implantation (TAVI) based on institutional experience in high-risk patients.
Review of clinical practice and institutional protocols based on 70 TAVI procedures performed at the Cape Mediclinic unit in South Africa.
Evaluated high-risk patients with severe aortic stenosis identified by an STS score >10% or EuroSCORE >20%.
Procedures utilized balloon-expandable Edwards SAPIEN valves (23mm or 26mm) via transfemoral, transapical, or transaortic approaches, primarily under general anaesthesia with transoesophageal echocardiography.
Observed a procedural mortality of 4.3% across the 70 TAVI cases managed by the multidisciplinary team.
Targeted frail patients at high surgical risk, noting literature benchmarks of 30-day mortality between 3.4% and 8.5% and a 1-year mortality of 25%.
Identified procedural complications requiring anaesthetic vigilance, including stroke, large blood loss, and post-procedural acute kidney injury reported in 12% of cases.

Structured PICO

P

Population

70 frail patients with severe aortic stenosis at high risk for surgical aortic valve replacement undergoing TAVI at a single South African center.

I

Intervention

Anaesthesia management for transcatheter aortic valve implantation (TAVI), primarily under general anaesthesia.

Limitations

Single-center experience
Lack of long-term outcome data

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Implication

TAVI is a complex procedure requiring meticulous anesthetic management, including pre-operative assessment, hemodynamic control, and rapid detection of complications.

Abstract

There are several reviews of anaesthesia for transcatheter aortic valve implantation (TAVI) in the literature. This article refl ects the practice of one South African TAVI unit (Cape Mediclinic unit) based on our experience with 70TAVI procedures. TAVI should never be regarded as a minor procedure. Patients selected for TAVI all have severe aortic stenosis (AS) and, by selection criteria, represent high risk for surgical aortic valve replacement. The salient points of anaesthesia management for TAVI are pre-operative assessment, haemodynamic management, anti-coagulation management and the detection of procedural complications.

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Cite This Study

Rocco Vivier (2017) conducted a review in Severe aortic stenosis (n=70). Transcatheter aortic valve implantation (TAVI) anaesthesia management was evaluated on Procedural mortality.

synapsesocial.com/papers/6ac19d70aeea5716e8c6c611 https://doi.org/10.24170/9-1-1869

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Anaesthesia for transcatheter aortic valve implantation (TAVI): An anaesthetist’s perspective

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Anaesthesia for transcatheter aortic valve implantation (TAVI): An anaesthetist’s perspective

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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