Cardio-anesthesiology considerations for the trans-catheter aortic valve implantation (TAVI) procedure

Melidi, Eleni; Latsios, George; Toutouzas, Kostas; Vavouranakis, Manolis; Tolios, Ioannis; Gouliami, M.; Gerckens, Ulrich; Tousoulis, Dimitris

doi:10.1016/j.hjc.2016.10.001

Cited by 25 publications

(14 citation statements)

References 58 publications

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“…In particular, transcatheter aortic valve implantation is considered an effective therapeutic alternative to surgical treatment for patients at high risk or for those who are not suitable or willing for open-heart surgery. 26 – 28 …”

Section: Commonest Conditions In Adults Requiring Cardiac Surgerymentioning

confidence: 99%

Assessment and pathophysiology of pain in cardiac surgery

Zubrzycki¹,

Liebold²,

Skrabal³

et al. 2018

JPR

139

106

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Analysis of the problem of surgical pain is important in view of the fact that the success of surgical treatment depends largely on proper pain management during the first few days after a cardiosurgical procedure. Postoperative pain is due to intraoperative damage to tissue. It is acute pain of high intensity proportional to the type of procedure. The pain is most intense during the first 24 hours following the surgery and decreases on subsequent days. Its intensity is higher in younger subjects than elderly and obese patients, and preoperative anxiety is also a factor that increases postoperative pain. Ineffective postoperative analgesic therapy may cause several complications that are dangerous to a patient. Inappropriate postoperative pain management may result in chronic pain, immunosuppression, infections, and less effective wound healing. Understanding and better knowledge of physiological disorders and adverse effects resulting from surgical trauma, anesthesia, and extracorporeal circulation, as well as the development of standards for intensive postoperative care units are critical to the improvement of early treatment outcomes and patient comfort.

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Section: Commonest Conditions In Adults Requiring Cardiac Surgerymentioning

confidence: 99%

Assessment and pathophysiology of pain in cardiac surgery

Zubrzycki¹,

Liebold²,

Skrabal³

et al. 2018

JPR

139

106

View full text Add to dashboard Cite

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“…There is a trend toward using local anesthesia with moderate sedation over general anesthesia in light of complications such as vasoplegia . However, the use of general anesthesia in the cath lab in certain cases cannot be avoided.…”

Section: Resultsmentioning

confidence: 99%

“…1 Eligibility for transcatheter procedures has also expanded to include octogenarians and high-risk individuals with decompensated comorbidities who may require general anesthesia. 2 Today's interventional cardiologist must therefore be well versed in the potential complications of general anesthesia and how to adequately manage them. We describe a case of refractory hypotension following Watchman™ implantation under general anesthesia with transesophageal echo (TEE) guidance and discuss the recognition, treatment, and prevention of this unique physiologic phenomenon.…”

Section: Introductionmentioning

confidence: 99%

“…From 2012 to 2015, the rate of transcatheter aortic valve replacements alone has increased by over 500% in the United States . Eligibility for transcatheter procedures has also expanded to include octogenarians and high‐risk individuals with decompensated comorbidities who may require general anesthesia . Today's interventional cardiologist must therefore be well versed in the potential complications of general anesthesia and how to adequately manage them.…”

Section: Introductionmentioning

confidence: 99%

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When the pressure drops: A case of vasoplegia during a structural heart intervention

Cox

Noveras

Harrell

et al. 2019

Cathet Cardio Intervent

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A 67‐year‐old male underwent general anesthesia for left atrial appendage occlusion. During the procedure, the patient developed catecholamine refractory hypotension requiring the administration of several vasopressin boluses to maintain adequate perfusion pressure. At the conclusion of the procedure, mild venous bleeding necessitated the administration of protamine. This led to a further decrease in the patient's blood pressure. Tamponade and continued volume loss were quickly ruled out leading to a diagnosis of vasoplegia syndrome (VS). The patient was appropriately treated with a vasopressin infusion with normalization of blood pressure and no significant morbidity or adverse outcome. With the use of general anesthesia during structural heart interventions on the rapid rise, we discuss the two common causes for vasoplegia along with evidence‐based treatments and possible prevention strategies.

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“…Ekibin tecrübesi arttıkça lokal anestezi ve sedasyon kombinasyonu tercihi ön plana çıkmaktadır. Lokal anestezi ve sedasyon kombinasyonu nörolojik komplikasyonların erken tespiti, kısa işlem süresi, derlenmenin hızlı olması, postoperatif bakım gereksinimini azaltması gibi avantajlara sahiptir (1) . Prosedürün invazivitesi ve stabil bir hemodinaminin elde edilmesinin zor olması, sedasyonun başlıca kısıtlıklarıdır.…”

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Transkateter Aort Kapak İmplantasyonuna (TAVI) Anestezi Yaklaşımı

Ak¹

2018

Kosuyolu Heart Journal

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Aort stenozu en sık görülen kalp kapak hastalığıdır ve cerrahi aort kapak replasmanı ile tedavi edilir. Transkateter aort kapak implantasyonu (TAVI) son yıllarda cerrahi aort kapak replasmanına alternatif olarak ortaya çıkmış ve ciddi aort stenozu olan inoperable veya yüksek cerrahi riskli hastaların tedavisinde temel dayanak olmuştur (Resim 1A,B).Hasta işlem öncesi kardiyoloji, anesteziyoloji ve kalp damar cerrahisi ekipleri ile birlikte değerlendirilmelidir. Bu işlemi olacak hastaların çoğu yaşlı ya da komorbiditesi yüksek hastalardır. Bu hasta grubu American Society of Anesthesiology (ASA) 3-4 olarak kabul edilirler. Anestezist hastayı ayrıntılı değerlendirmeli, olası komplikasyonlara karşı hazırlıklı olmalıdır. İşlem öncesi en az 2 ünite eritrosit süspansiyonu hazır bulundurulmalıdır. Ayrıca cerrahi ekip, perfüzyonist ve ameliyathane odası olası cerrahi müdahale için hazır bekletilmelidir.Antitrombosit tedavi ile ilgili spesifik klavuzlar hala TAVI için mevcut olmamakla birlikte yaygın uygulama işlem öncesi 300 mg aspirin ve 300 mg klopidogrel uygulanması şeklindedir. İşlem sırasında 5000 İÜ heparin uygulanır ve ACT > 250 olması beklenir. Postoperatif dönemde 75 mg-100 mg aspirin ve 75 mg klopidogrel günlük dozu devam ettirilir. Böbrek yetmezliğinin önüne geçmek için bir gün öncesi kristalloidler ile hidrasyon sağlanmalıdır. Antihipertansif ilaçlar işlem gününe kadar devam ettirilmelidir.Hasta monitörizasyonunda 5 elektrotlu EKG, pulse oksimetre, hasta sıcaklığı, kapnografi, mesane sonda kateteri ile saatlik idrar takibi, radiyal arter kateterizasyonu ile invaziv kan basıncı izlemi, aralıklı kan gazı takibi, harici defibrilatör pedleri, gerekirse santral venöz kateter takılması önerilir.TAVI için anestezi tekniği seçimi yapılacak işlemin özelliğine, hastanın mevcut hastalıklarına, ekibin işlemdeki tecrübesine bağlı olarak değişebilir. Genel anestezi uygulaması Resim 1(A,B). Kateter laboratuvarında transkateter aort kapak implantasyonu (TAVI) işlemi. (A) Kapak aort kapağına park edilmiş (Ok), (B) Kapak implantasyonu tamamlanmış (Ok).

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Cardio-anesthesiology considerations for the trans-catheter aortic valve implantation (TAVI) procedure

Cited by 25 publications

References 58 publications

Assessment and pathophysiology of pain in cardiac surgery

Assessment and pathophysiology of pain in cardiac surgery

When the pressure drops: A case of vasoplegia during a structural heart intervention

Transkateter Aort Kapak İmplantasyonuna (TAVI) Anestezi Yaklaşımı

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