Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Department of Anesthesiology, Onassis Cardiac Surgery Center, Athens, Greece.
J Cardiothorac Vasc Anesth. 2021 Jun;35(6):1737-1746. doi: 10.1053/j.jvca.2020.09.088. Epub 2020 Sep 7.
Transcatheter aortic valve replacement (TAVR) has become an alternative treatment for patients with symptomatic aortic stenosis not eligible for surgical valve replacement due to a high periprocedural risk or comorbidities. However, there are several areas of debate concerning the pre-, intra- and post-procedural management. The standards and management for these topics may vary widely among different institutions and countries in Europe.
Structured web-based, anonymized, voluntary survey.
Distribution of the survey via email among members of the European Association of Cardiothoracic Anaesthesiology working in European centers performing TAVR between September and December 2018.
Physicians.
The survey consisted of 25 questions, including inquiries regarding number of TAVR procedures, technical aspects of TAVR, medical specialities present, preoperative evaluation of TAVR candidates, anesthesia regimen, as well as postoperative management. Seventy members participated in the survey. Reporting members mostly performed 151-to-300 TAVR procedures per year. In 90% of the responses, a cardiologist, cardiac surgeon, cardiothoracic anesthesiologist, and perfusionist always were available. Sixty-six percent of the members had a national curriculum for cardiothoracic anesthesia. Among 60% of responders, the decision for TAVR was made preoperatively by an interdisciplinary heart team with a cardiothoracic anesthesiologist, yet in 5 countries an anesthesiologist was not part of the decision-making. General anesthesia was employed in 40% of the responses, monitored anesthesia care in 44%, local anesthesia in 23%, and in 49% all techniques were offered to the patients. In cases of general anesthesia, endotracheal intubation almost always was performed (91%). It was stated that norepinephrine was the vasopressor of choice (63% of centers). Transesophageal echocardiography guiding, whether performed by an anesthesiologist or cardiologist, was used only ≤30%. Postprocedurally, patients were transferred to an intensive care unit by 51.43% of the respondents with a reported nurse-to-patient ratio of 1:2 or 1:3, to a post-anesthesia care unit by 27.14%, to a postoperative recovery room by 11.43%, and to a peripheral ward by 10%.
The results indicated that requirements and quality indicators (eg, periprocedural anesthetic management, involvement of the anesthesiologist in the heart team, etc) for TAVR procedures as published within the European guideline are largely, yet still not fully implemented in daily routine. In addition, anesthetic TAVR management also is performed heterogeneously throughout Europe.
经导管主动脉瓣置换术（TAVR）已成为一种替代治疗方法，适用于因围手术期风险高或合并症而不适合手术瓣膜置换的有症状主动脉瓣狭窄患者。然而，在术前、术中及术后管理方面仍存在几个争议领域。这些主题的标准和管理在欧洲的不同机构和国家之间可能存在很大差异。
基于网络的结构化、匿名、自愿调查。
2018 年 9 月至 12 月期间，通过电子邮件向在欧洲中心进行 TAVR 的欧洲心胸麻醉协会成员分发调查。
医生。
该调查包括 25 个问题，涉及 TAVR 程序的数量、TAVR 的技术方面、存在的医学专业、TAVR 候选者的术前评估、麻醉方案以及术后管理。70 名成员参与了调查。报告成员每年主要进行 151 至 300 例 TAVR 手术。在 90%的回复中，始终有心脏病专家、心脏外科医生、心胸麻醉师和灌注师在场。66%的成员有国家心胸麻醉课程。在 60%的应答者中，TAVR 的决策是由一个跨学科的心脏团队做出的，其中包括一名心胸麻醉师，但在 5 个国家，麻醉师并不参与决策。40%的回复采用全身麻醉，44%采用监测麻醉护理，23%采用局部麻醉，49%的患者都提供了所有技术。在全身麻醉的情况下，几乎总是进行气管插管（91%）。结果表明，去甲肾上腺素是首选的血管加压药（63%的中心）。食管超声心动图引导，无论是由麻醉师还是心脏病专家进行，仅使用了≤30%。术后，51.43%的受访者将患者转至重症监护病房，报告的护士与患者比例为 1:2 或 1:3，27.14%转至麻醉后护理病房，11.43%转至术后恢复室，10%转至外周病房。
结果表明，TAVR 手术的要求和质量指标（例如，围手术期麻醉管理、麻醉师参与心脏团队等）在欧洲指南中公布，但在日常实践中尚未完全实施，尽管已经得到了广泛的应用。此外，欧洲各地的麻醉 TAVR 管理也存在很大差异。
