Perioperative Management of Transcatheter Aortic Valve Implantation

Abstract

Transcatheter Aortic Valve implantation has developed out of an interest and a need for ameliorating aortic valvular disease, specifically degenerative calcific valvular stenosis in elderly high-risk patients. In a recent review, it was found that one third of patients who could benefit from AVR do not receive such treatment because of advanced age or significant comorbidities. Our Anesthetic experiences have revealed this procedure to be feasible, even with a high-risk population. Transcatheter valve implantation might provide these high-risk surgical candidates the opportunity for definitive treatment of their aortic stenosis. Anesthesiologists must be aware of current technology, playing a participative role in developing standards of care for these high-risk patients and supporting the continuous refinement toward a more minimally invasive approach. To date, the TAVI approach to repairing valve disorders has met with considerable success and promises to be a heavily used technology in the future. Early reports from Europe indicated that the procedure can be performed with success comparable with the open surgical approach in patients who might otherwise be deemed inoperable. However, the early reports also revealed that a learning curve is involved, and new-generation and improved bioprosthetic devices have made an impact on procedural success.