Percutaneous aortic valve replacement: overview and suggestions for anesthestic management

Journal of Clinical Anesthesia
Hermann HeinzeMatthias Heringlake

Abstract

Transcutaneous aortic valve replacement (AVR) is increasingly used for high-risk patients with severe aortic stenosis, who have high operative mortality for surgical placement during cardiopulmonary bypass (CPB). Retrograde transfemoral AVR is usually performed during sedation, whereas antegrade transapical AVR is done with general anesthesia. Both procedures can be carried out without CPB. Extended hemodynamic monitoring, including pulmonary artery catheterization and transesophageal echocardiography, may be useful. Transfemoral AVR requires placement of a transvenous right ventricular pacing lead. Typical complications include local bleeding, obstruction of the coronary ostia, and neurological insult due to embolization of sclerotic material. Aortic regurgitation due to paravalvular leakage or inadequate device expansion also may occur. Renal function may deteriorate on excessive application of contrast medium. Atrioventricular blocks may occur later rather than after conventional AVR which tend to occur immediately.

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Citations

Oct 6, 2012·Journal of Cardiothoracic and Vascular Anesthesia·Kelly A BuftonFrederick C Cobey
May 21, 2013·Revista brasileira de anestesiologia·Tailur Alberto GrandoGuilherme Bernardi
Jul 3, 2015·Seminars in Cardiothoracic and Vascular Anesthesia·Breandan Lawrence SullivanNatalie Hamilton
Dec 17, 2020·Expert Review of Cardiovascular Therapy·Farhala BalochAamir Hameed Khan

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