Transcatheter aortic valve replacement in high risk patients with different anaesthetic techniques

摘要

Age related aortic stenosis occurs in 2-3% of those over the age of 65. With the aging of the population in general, aortic valve disease is rapidly increasing. With only about 200,000 aortic valve replacements (AVR) carried out worldwide per year, a large number of patients with symptomatic aortic stenosis are not treated. Many of them are considered at too high risk to undergo open heart surgery due to age or comorbidity [1,2] and this led to a growing interest in the development of less invasive methods of AVR. In 1985, Cribier in Rouen (France) performed the first successful percutaneous aortic valvuloplasty, but before that, during the 80´s, Henning Rud Andersen in Aarhus (Denmark), actually experimented with expanding bioprosthetic stent valves implanted in pigs [3]. In 2002, Cribier conducted the first percutaneous AVR in a human. [4,5,6]. In our institution, patients considered for retrograde percutaneous aortic valve replacement (PAVR) are patients with severe symptomatic aortic stenosis who are 75 years of age, or, are 65 years and either have a standard EUROscore (European System Operation Risk Evaluation) 15% or at least one of the following risk factors: previous heart surgery, glass aorta, pulmonary disease, liver cirrhosis, right ventricular heart failure, thoracic trauma as from radiotherapy, cachexia or obesity [7]. These factors must of course be considered individually according to their severity. The aim of this study was to compare anaesthetic depth and hemodynamic stability between total intravenous propofol anaesthesia and sevoflurane anaesthesia for PAVR.