Saroul C, Keller G, Benaissa M, Lehot J J
Hôpital Cardio-Vasculaire et Pneumologique Louis Pradel - Groupement Hospitalier Est, 59 Boulevard Pinel, 69677 Bron cedex, France.
Ann Fr Anesth Reanim. 2011 May;30 Suppl 1:S38-43. doi: 10.1016/S0750-7658(11)70009-0.
The objectives are to present the different minimally invasive cardiac surgery techniques to repair the mitral valve, TAVI and MitraClip, as well as the implications for the anaesthetist. Evaluate retrospectively the anaesthesist methods, change in monitoring and how the patients are selected. The mitral valve repair by minithoracotomy and video-surgery requires selective left intubation and monitoring by TEE. The TAVI methods seem to be working best under local anaesthesia and sedation for haemodynamic and neurologic monitoring. The MitraClip surgery requires an extensive monitoring during and after surgery. In conclusion, the care of patients that are candidates for a TAVI requires the same level of expertise as anaesthesiology in cardiac surgery. The number of procedures performed under sedation will increase. These patients require multidisciplinary care (surgeons, cardiologists, sonographers and anaesthesiologists) due to comorbidities, and the possible haemodynamic, neurologic and vascular complications. These patients have an Euroscore greater than 20% and a STS score greater than 10%. In our experience, 80% of the cases are done femorally, 17% of the cases are done through the subsclavian artery (Corevalve(®)). 80% of the patients have surgery with a local anaesthesia and sedation. 20% of the patients get surgery with general anaesthesia. For the Edwards-Sapien(®) valve, when the femoral approach is impossible, the patient can get surgery with general anaesthesia using the transapical access.
目的是介绍修复二尖瓣的不同微创心脏手术技术，即经导管主动脉瓣置入术（TAVI）和二尖瓣夹合术（MitraClip），以及对麻醉医生的影响。回顾性评估麻醉医生的方法、监测的变化以及患者的选择方式。通过胸腔镜小切口和视频手术进行二尖瓣修复需要选择性左肺插管并采用经食管超声心动图（TEE）监测。TAVI方法在局部麻醉和镇静下进行血流动力学和神经学监测时似乎效果最佳。MitraClip手术在手术期间和术后需要广泛的监测。总之，对适合TAVI的患者的护理需要与心脏手术麻醉学相同水平的专业知识。在镇静下进行的手术数量将会增加。由于合并症以及可能出现的血流动力学、神经学和血管并发症，这些患者需要多学科护理（外科医生、心脏病专家、超声心动图医生和麻醉医生）。这些患者的欧洲心脏手术风险评估系统（Euroscore）大于20%，胸外科医师协会（STS）评分大于10%。根据我们的经验，80%的病例通过股动脉进行，17%的病例通过锁骨下动脉（Corevalve(®)）进行。80%的患者在局部麻醉和镇静下进行手术。20%的患者接受全身麻醉手术。对于爱德华兹-赛沛（Edwards-Sapien(®)）瓣膜，当无法采用股动脉入路时，患者可通过经心尖入路在全身麻醉下进行手术。
