Pro: Transcatheter Aortic Valve Implantation Should Be Performed With General Anesthesia

Abstract

p c p r d w w m TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI) should be performed under general anesthesia (GA). Presently, GA has been shown to be the most commonly used anesthesia technique.1-4 In Europe at present, aortic valve access via the transapical, transfemoral, and transaxillary approaches is used in conjunction with the 2 clinically used aortic valve prostheses. Cribier et al5 are acknowledged for the first successful imlantation in 2002. Since then, there has been rapid developent in the field of TAVI,6-10 along with the publication of rospective multicenter studies11,12 providing evidence of reduced morbidity and mortality. These techniques are still recommended for high-risk patients13 who frequently are considred ineligible for surgery. The breakthrough development of hese catheter-based techniques has fundamentally changed the pproach to the treatment of aortic valve stenosis in high-risk atients. The treatment of aortic valve stenosis with TAVI equires a multidisciplinary team approach involving a cardiac urgeon, a cardiologist, and a cardiac anesthesiologist. The anesthesia team and the selection of the anesthesia echnique are important for the outcome of these high-risk atients. The transapical and the transaxillary approaches neessitate GA because of the minithoracotomy and the need for echanical ventilation. On the one hand, GA provides a quiet nd pain-free patient for transfemoral and transapical TAVI. he airway is maintained throughout the procedure, and there s no risk of emergency intubation, especially in patients with difficult airway and monitored anesthetic care (MAC) mangement. Ender et al14 and Hantschel et al15 have shown that fast-track GA is favorable for the cardiac surgical patient, even for the high-risk population, such as patients considered for TAVI. MAC with local anesthesia of the groin plus sedation is feasible for the transfemoral approach16-18 and is integrated into the clinical practice of some centers. There is ongoing scientific and clinical debate regarding the optimal anesthesia technique with the transfemoral aortic valve implantation regardless of the valve used. The theoretic advantages of the MAC technique include continuous neurologic assessment of the awake patient, earlier mobilization, and, potentially, a faster recovery, which may reduce the length of stay in high-dependency units and the overall hospital stay due to the fact that the patient is not intubated. Furthermore, the hemodynamic changes may be