Anesthesia and perioperative management of patients undergoing transcatheter aortic valve implantation: analysis of 90 consecutive patients with focus on perioperative complications.

摘要

OBJECTIVE: To describe, from the point of view of anesthesia and intensive care specialists, the perioperative management of high-risk patients with aortic stenosis who underwent transcatheter (transfemoral and transapical) aortic valve implantation (TAVI). The authors specifically focused on immediate postoperative complications. DESIGN: Retrospective review of collected data. SETTING: Academic hospital. PARTICIPANTS: Ninety consecutive patients with severe aortic stenosis who underwent TAVI. INTERVENTIONS: General anesthesia followed by postoperative care. Complications were defined by pre-established criteria. MEASUREMENTS AND MAIN RESULTS: Of 184 patients referred between October 2006 and February 2009, 90 were consecutively treated with TAVI because of a high surgical risk or contraindications to surgery. The transfemoral approach was used as the first option (n = 62), and the transapical approach when contraindications to the former were present (n = 28). Results are presented as mean +/- standard deviation or median (25-75 percentiles) as appropriate. Patients were 81 +/- 8 years old, in New York Heart Association classes II (9%), III (54 %), or IV (37%); left ventricular ejection fraction was below 0.5 in 38% of patients. The predicted surgical mortality was 24% (16-32) and 15% (11-23) with the logistic EuroSCORE and STS-Predicted Risk of Mortality, respectively. The valve was implanted in 92% of the cases. The duration of anesthesia and (intra- and postoperative) mechanical ventilation was 190 (160-230) minutes and 245 (180-420) minutes, respectively. Hospital mortality was 11%. The most frequent cardiac complications were heart failure (20%) and atrioventricular block (16%), with 6% requiring a pacemaker. Vascular complications (major and minor) occurred in 29% of the patients. CONCLUSIONS: Despite their severe comorbidities, the mortality of the patients in this cohort was below that predicted by cardiac surgery risk scores. Monitoring, hemodynamic instability, and the frequency of complications require management and follow-up of these patients in similar ways as for open cardiac surgery. The frequency of complications in this cohort was comparable to that published by other groups.