Anesthesia for transcatheter aortic valve implantation

Abstract

To summarize and highlight recent advances in the periprocedural management of patients undergoing transcatheter aortic valve implantation (TAVI). TAVI has become the new standard of care in inoperable patients with severe aortic valve stenosis and has emerged as an alternative to surgical aortic valve replacement in patients with high operative risk. Although TAVI is mainly performed via the transfemoral route, other access options are available including the transapical approach. Although TAVI has become a routine procedure, it is still associated with potentially life-threatening complications. TAVI should ideally be performed in a dedicated hybrid room by a multidisciplinary team involving cardiac anesthesiologists. Owing to a lack of validated risk scores, indication and treatment allocation still have to rely on clinical judgment. Owing to the severity of the underlying disease and the complexity of the procedure, TAVI patients require extensive monitoring and installation. The avoidance of prolonged hypotension is the most important goal to prevent hemodynamic deterioration. Transfemoral TAVI procedures can be performed under conscious sedation. Transesophageal echocardiography is an important tool for procedural guidance and the instantaneous detection of complications. Anesthesiologists involved in TAVI must have detailed knowledge of valvular heart disease, hemodynamics, echocardiography, the procedure, and associated complications.