Department of Anesthesia and Intensive Care, Vita-Salute San Raffaele University, Milan, Italy.
Minerva Anestesiol. 2010 Feb;76(2):100-8.
Transcatheter aortic valve implantation (TAVI) is an emergent alternative technique to surgery in high-risk patients with aortic stenosis. Here, we describe the anesthesiological management of patients undergoing TAVI at our institution over an 18-month period.
After a proper assessment of surgical risk and comorbidities, 69 patients underwent TAVI with the transfemoral/subclavian approach. Both Edwards-Sapien and Corevalve prostheses were implanted. The anesthetic regimen consisted of general anesthesia or local anesthesia plus sedation.
Twenty-seven patients received general anesthesia, and 42 received local anesthesia plus sedation. Procedural complications included prosthesis embolization (2), ascending aorta dissection (1), ventricular fibrillation following rapid ventricular pacing (8), vascular access site complications (17), and the valve-in-valve procedure (1). Three patients had to be converted from local anesthesia to general anesthesia (one patient had refractory ventricular fibrillation, and two patients were restless). All patients were alive at the 30-day follow-up. Mechanical ventilation time was 8.5+/-0.03 h. Mean ICU stay was 20.1+/-2.89 h. Postoperative complications included acute renal dysfunction (11), advanced atrioventricular block (9), and stroke (1). Thirty-six out of 42 (86%) patients were alive at the 6-month follow-up.
TAVI is feasible in high-risk patients who would not be able to undergo surgical valve replacement. Hemodynamic management is the main concern of intraoperative anesthesiological management. General or local anesthesia plus sedation are both valid alternative techniques that can be titrated according to patient characteristics. Close postoperative monitoring in the ICU is required.
经导管主动脉瓣植入术（TAVI）是高危主动脉瓣狭窄患者手术的一种紧急替代技术。在此，我们描述了我们机构在 18 个月期间对接受 TAVI 的患者的麻醉管理。
在对手术风险和合并症进行适当评估后，69 例患者采用经股/锁骨下途径进行 TAVI。植入了 Edwards-Sapien 和 Corevalve 假体。麻醉方案包括全身麻醉或局部麻醉加镇静。
27 例患者接受全身麻醉，42 例患者接受局部麻醉加镇静。手术并发症包括假体栓塞（2 例）、升主动脉夹层（1 例）、快速心室起搏后心室颤动（8 例）、血管入路部位并发症（17 例）和瓣中瓣手术（1 例）。3 例患者需要从局部麻醉转为全身麻醉（1 例患者出现难治性心室颤动，2 例患者烦躁不安）。所有患者在 30 天随访时均存活。机械通气时间为 8.5±0.03 小时。平均 ICU 入住时间为 20.1±2.89 小时。术后并发症包括急性肾功能障碍（11 例）、高级房室传导阻滞（9 例）和中风（1 例）。42 例患者中有 36 例（86%）在 6 个月随访时存活。
TAVI 适用于不能接受外科瓣膜置换的高危患者。血流动力学管理是术中麻醉管理的主要关注点。全身麻醉或局部麻醉加镇静都是可行的替代技术，可以根据患者的特点进行滴定。术后在 ICU 密切监测是必需的。
