Anesthetic management and perioperative complications in transcatheter aortic valve implantation: the Turkish experience

Gümüş, Tülin; Kesimci, Elvin; Soykut, Cem; Kanbak, Orhan; But, Abdülkadir

doi:10.3906/sag-1305-49

Cited by 4 publications

(6 citation statements)

References 31 publications

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“…After the particular preoperative evaluation for the risk assessment, all procedures should be performed in a hybrid operation room including imaging systems such as angiography. Our anaesthetic management was similar to the previously reported studies [14][15][16][17]. Providing and maintaining the hemodynamic stability was the main objective of our anaesthetic management during the procedure.…”

Section: Discussionmentioning

confidence: 52%

“…30-day mortality rate was 11.4% and nine-month mortality rate was 25.7% in their study. In a recent study [17], 30-day mortality following the TAVI procedure was reported as 9%. On the other hand, in Bergmann et al 's study [19] the first three procedural complications for the patients who underwent TAVI under general anaesthesia were permanent pacemaker implantation (22%), femoral artery dissection (14%)renal failure requiring dialysis (8%), and 30-day mortality was 10% and 1-year mortality was 16%.…”

Section: Discussionmentioning

confidence: 99%

“…All patients in our study received general anaesthesia with endotracheal intubation because the procedure team preferred general anaesthesia in order to allow the use of TEE during the TAVI procedure. In a recent study, Gümüs et al [17] evaluated 79 patients who underwent TAVI in a single centre in Turkey. Similar to our study, all patients in their study received general anaesthesia under fluoroscopic and TEE guidance.…”

Section: Discussionmentioning

confidence: 99%

“…There are numerous studies including the results of TAVI applications in many countries [10][11][12][13][14]. However, there are a limited number of studies on TAVI procedure in Turkey [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

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Transcatheter Aortic Valve Implantation: First Applications and Short Term Outcomes in Our Clinic

et al. 2015

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Objective: The objective of this study is to evaluate the first applications and short term outcomes of transcatheter aortic valve implantation (TAVI) in our clinic, which is a new technology for the patients with high risk for surgical aortic valve replacement (SAVR). Materials and Methods:Between January 2010 and December 2012, twenty five patients (16 males, 9 females; mean age 74.04±8.86 years) diagnosed with severe aortic stenosis, who were at high risk for surgery (EuroSCORE II: 5.58±4.20) and underwent TAVI in our clinic, were evaluated. The demographic and clinical characteristics of patients, anaesthetic management, complications during pre-and post-operative periods and the mortality rate in the first 30 days and six months were recorded.Results: Edwards SAPIEN Valve prostheses were implanted by transfemoral approach (percutaneously in 10 patients and surgically in 15 patients) in all patients. The TAVI procedure was performed under general anaesthesia. The success rate of the TAVI procedure was 100%. Three patients had limited dissection of the femoral artery; however, intervention was not needed due to good distal perfusion rate. Permanent pacemaker was implanted to four patients because of long-term atrioventricular blockage. After the procedure, all patients were transferred to the Intensive Care Unit (ICU) and all patients were extubated in the ICU. The mean mechanical ventilation duration (minutes) was 166.20±39.32, the mean critical care unit stay (day) was 5.64±2.99 and the mean hospital stay (day) was 11.92±5.54. Acute renal failure was observed in one patient and stroke was observed in two patients on the first postoperative day. The mortality rate in the first 30 days and 6 months was found to be 4% and 16%, respectively. Conclusion:Transcatheter aortic valve implantation is a great option for patients with severe aortic stenosis who are at high risk for SAVR. In our institute, procedural success and short term outcomes for patients underwent TAVI were found to be similar to the other studies in the national and international literature. Bulgular: Tüm hastalarda Edwards SAPIEN Valve protez transfemoral yaklaşımla (10 hastada perkutanöz, 15 hastada cerrahi yöntemle) yerleştirildi. Tüm hastalarda TAVI işlemi genel anestezi altında yapıldı ve transözefagial ekokardiyografi tüm hastalara uygulandı. TAVI işleminin başarı oranı %100 idi. İşlem süresince mortalite ve ciddi komplikasyon izlenmedi. Üç hastada femoral arterde sınırlı disseksiyon görüldü, ancak distal perfüzyonun iyi olması nedeniyle herhangi bir müdahale gerekmedi. Uzun süreli atriyoventriküler blokaj nedeniyle dört hastaya kalıcı pacemaker takıldı. İşlem sonrası, tüm hastalar Yoğun Bakım Ünitesi'ne (YBÜ) gönderildi ve tüm hastalar YBÜ'de ekstübe edildi. Ortalama mekanik ventilasyon süresi (dakika): 166,20±39,32, ortalama yoğun bakımda kalış süresi (gün): 5,64±2,99 ve ortalama hastanede kalış süresi (gün): 11,92 ±5,54 idi. Postoperatif birinci gün, bir hastada akut renal yetmezlik ve iki hastada inme izlendi. İlk 30 gündeki mo...

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Transcatheter Aortic Valve Implantation: First Applications and Short Term Outcomes in Our Clinic

et al. 2015

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“…Some authors prefer GA even after an initial experience with sedation. Gümüş et al and Yamamoto et al preferred local anesthesia and sedation in their practice after a period of experience with GA (17,25). Yamamoto et al failed to show any difference in procedure success; 30-day mortality and the difference in length of stay in the ICU and hospital was significant in the sedation group in comparison to the GA group.…”

Section: Discussionmentioning

confidence: 99%

Impact of different anesthetic managements in outcomes of transcatheteraortic valve implantation: the first Turkish experience

Kesimci¹,

Erkılıç²,

Gümüş³

et al. 2016

Turk J Med Sci

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We investigated the data of patients retrospectively in regards to anesthetic issues. Between July 2011 and January 2014, 151 TAVI procedures were performed via a transaxillary (n = 3) or transfemoral (n = 148) approach at our institution.Routinely, following the evaluation of the individual patient on the basis of international recommendations by the cardiologist, cardiac surgeon, and anesthesiologist, a decision for not only high risk of conventional surgery but also the suitability of TAVI is made in our clinics (8-12). Preoperatively, in addition to clinical evaluation, all patients are screened by transthoracic echocardiography (TTE), coronary angiography, iliofemoral contrast angiography, and computed tomography. Thus, the anesthesiologist determines the anesthetic management to be offered.For this report, the patients were followed up in the aspect of clinical data, transthoracic echocardiographic results, parameters related to the procedure, and intensive care unit and hospital stay lengths until hospital discharge. Afterwards, information on survival in the following 30 days was obtained by telephoning the patient. We Background/aim: Transcatheter aortic valve implantation (TAVI) has emerged as a new therapy in aortic stenosis patients with high operative risk. Advances in experiences have shifted the choice of anesthesia from general to local anesthesia and sedation for these patients. We compared our anesthetic experiences in our institute in a period of 2.5 years. Materials and methods:A total of 151 (86 females, 65 males, mean age 76 years) symptomatic aortic stenosis patients undergoing transfemoral TAVI under general anesthesia (GA) (n = 79) and local anesthesia and sedation (LAS) (n = 72) were evaluated retrospectively in regards to anesthetic issues. Results:The mean European System for Cardiac Operative Risk Evaluation (EuroSCORE) values of patients in the GA and LAS groups were 17 and 12, respectively. The anesthesia duration was significantly shorter in the LAS group (P < 0.001) and 16.7% of the patients in the LAS group were switched to general anesthesia. Length of stay in the intensive care unit was similar in the two groups.Conclusion: TAVI, applied in high-risk populations, has many challenges for anesthesiologists. With technological advances, it is possible to perform these procedures under sedation with variable advantages. Thus, future studies in regard to anesthesia are required for the success of the procedure and patient safety.

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Advances in the Anesthetic Management of Transcatheter Aortic Valve Implantation

Wang

Zhang

2018

Journal of Cardiothoracic and Vascular Anesthesia

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Anesthetic management and perioperative complications in transcatheter aortic valve implantation: the Turkish experience

Cited by 4 publications

References 31 publications

Transcatheter Aortic Valve Implantation: First Applications and Short Term Outcomes in Our Clinic

Transcatheter Aortic Valve Implantation: First Applications and Short Term Outcomes in Our Clinic

Impact of different anesthetic managements in outcomes of transcatheteraortic valve implantation: the first Turkish experience

Advances in the Anesthetic Management of Transcatheter Aortic Valve Implantation

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