Anesthesia Management for Transapical Transcatheter Aortic Valve Implantation: A Case Series

Fassl, Jens; Walther, Thomas; Groesdonk, Heinrich Volker; Kempfert, Joerg; Borger, Michael Andrew; Scholz, Markus; Mukherjee, Chirojit; Linke, Axel; Schuler, Gerhard; Mohr, Friedrich Wilhelm; Ender, Joerg

doi:10.1053/j.jvca.2008.12.026

« Previous Next »Journal of Cardiothoracic and Vascular Anesthesia
Volume 23, Issue 3 , Pages 286-291, June 2009

Anesthesia Management for Transapical Transcatheter Aortic Valve Implantation: A Case Series

Jens Fassl, MD
- Department of Anesthesiology and Intensive Care II, University of Leipzig, Heart Center, Leipzig, Germany
Thomas Walther, MD, PhD
- Department of Cardiac Surgery, University of Leipzig, Heart Center, Leipzig, Germany
Heinrich Volker Groesdonk, MD
- Department of Anesthesiology and Intensive Care II, University of Leipzig, Heart Center, Leipzig, Germany
Joerg Kempfert, MD
- Department of Cardiac Surgery, University of Leipzig, Heart Center, Leipzig, Germany
Michael Andrew Borger, MD, PhD
- Department of Cardiac Surgery, University of Leipzig, Heart Center, Leipzig, Germany
Markus Scholz, PhD
- Insitute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
Chirojit Mukherjee, MD
- Department of Anesthesiology and Intensive Care II, University of Leipzig, Heart Center, Leipzig, Germany
Axel Linke, MD
- Department of Cardiology, University of Leipzig, Heart Center, Leipzig, Germany
Gerhard Schuler, MD, PhD
- Department of Cardiology, University of Leipzig, Heart Center, Leipzig, Germany
Friedrich Wilhelm Mohr, MD, PhD
- Department of Cardiac Surgery, University of Leipzig, Heart Center, Leipzig, Germany
Joerg Ender, MD
- Department of Anesthesiology and Intensive Care II, University of Leipzig, Heart Center, Leipzig, Germany
- Address reprint requests to Joerg Ender, MD, Department of Anesthesiology and Intensive Care II, University of Leipzig, Leipzig Heart Center, Struempellstrasse 39, 04289 Leipzig, Germany

published online 26 February 2009.

Objective

The purpose of this study was to review the management of anesthesia for transapical transcatheter aortic valve implantation.

Design

Retrospective review of collected data.

Setting

University-affiliated heart center.

Participants

One hundred consecutive patients with severe aortic stenosis.

Interventions

General anesthesia followed by an established fast-track protocol.

Materials and Methods

A total of 100 patients with significant AS received transapical transcatheter aortic valve implantation. The patients were treated following a fast-track protocol. The mean arterial pressure was maintained above 65 mmHg by volume and/or inotropes during the procedure. The mean arterial pressure was increased above 75 mmHg to avoid hemodynamic deterioration before starting rapid ventricular pacing for the balloon valvuloplasty and the valve implantation. Transesophageal echocardiography was used to assess valve size and for hemodynamic monitoring. Eighty-one patients were treated completely off pump. There was a significant decline in mean arterial pressure from pre- to postvalvuloplasty (74.7 ± 9.1 mmHg v 63.6 ± 11.3 mmHg, p < 0.001) and from pre- to postimplantation (76.5 ± 12.6 mmHg v 67.2 ± 12.7, p < 0.001). The first 10 patients in the study intentionally were placed on cardiopulmonary bypass, and 9 patients required cardiopulmonary bypass because of hemodynamic deterioration.

Conclusion

A well-designed anesthetic plan as well as an understanding of the surgical procedure and the hemodynamic effects of rapid ventricular pacing are required to ensure successful outcomes in this new surgical option for high-risk patients.

Key Words: anesthesia, transcatheter transapical aortic valve replacement