TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) is an alternative to surgery in patients with severe aortic valve stenosis who are at high surgical risk.
1The most common approach is via the femoral artery. Other approaches are possible, notably via the carotid artery or via a transapical route by left mini thoracotomy in patients with severe atherosclerosis. A transfemoral access procedure is carried out under general anesthesia or monitored anesthesia care with sedation.
- Mack M.J.
- Leon M.B.
- Smith C.R.
- et al.
5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): A randomised controlled trial.
Lancet. 2015; 385: 2477-2484
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Patient selection and outcomes of transfemoral transcatheter aortic valve replacement performed with monitored anesthesia care versus general anesthesia.
J Cardiothorac Vasc Anesth. 2017; 31: 2049-2054
3However, for the transapical procedure, general anesthesia remains the main option. In cardiac surgery, high thoracic epidural anesthesia may lead to neuroaxial hematoma and hypotension secondary to sympatholysis. Serratus anterior plane block (SAPB) provides effective anesthesia of the chest wall. It could be an alternative to general anesthesia for patients eligible for TAVR.
- Lester L.
- Brady M.B.
- Brown C.H.
Sedation versus general anesthesia for TAVR: Where do we go from here?.
J Cardiothorac Vasc Anesth. 2017; 31: 2055-2057
- Blanco R.
- Parras T.
- McDonnell J.G.
- et al.
Serratus plane block: A novel ultrasound-guided thoracic wall nerve block.
Anaesthesia. 2013; 68: 1107-1113
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- 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): A randomised controlled trial.Lancet. 2015; 385: 2477-2484
- Patient selection and outcomes of transfemoral transcatheter aortic valve replacement performed with monitored anesthesia care versus general anesthesia.J Cardiothorac Vasc Anesth. 2017; 31: 2049-2054
- Sedation versus general anesthesia for TAVR: Where do we go from here?.J Cardiothorac Vasc Anesth. 2017; 31: 2055-2057
- Serratus plane block: A novel ultrasound-guided thoracic wall nerve block.Anaesthesia. 2013; 68: 1107-1113
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Published online: February 02, 2018
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