Difference between revisions of "Transcatheter aortic valve replacement"
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TAVR, also sometimes referred to as TAVI [Transcatheter Aortic Valve Implantation], is an alternative to surgical repair/replacement of heavily diseased/calcified aortic valves contributing to significant aortic stenosis. It involves placing an artificial valve over the existing diseased aortic valve, guided by angiography and fluoroscopy. | |||
== Preoperative management == | == Preoperative management == | ||
Revision as of 09:38, 27 June 2022
| Anesthesia type |
MAC vs. GA |
|---|---|
| Airway |
Natural airway vs. ETT |
| Lines and access |
2 large bore PIV + art line (left preferred) |
| Monitors |
Standard, ABP |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative | |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
TAVR, also sometimes referred to as TAVI [Transcatheter Aortic Valve Implantation], is an alternative to surgical repair/replacement of heavily diseased/calcified aortic valves contributing to significant aortic stenosis. It involves placing an artificial valve over the existing diseased aortic valve, guided by angiography and fluoroscopy.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular | |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Type and Cross 2 units of pRBCs
Operating room setup
Often done in a remote anesthesia setting.
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
2 PIVs: one for infusion. one for push line.
If doing MAC: do not need to place an invasive A-line. Cardiologists will place a femoral and radial A-line that will monitor aortic and LV pressures; these can be used intra-op by the anesthesia team to monitor BP. Can use a non-invasive a-line such as a clear-sight if available.
If doing GA, place arterial line prior to induction.
Induction and airway management
Positioning
Supine, arms tucked
Maintenance and surgical considerations
For MAC cases, can consider starting with remifentanil 0.02mcg/kg/min titrated to effect +/- propofol 20mcg/kg/min titrated to effect.
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Complete heart block, stroke, MI, aortic dissection, contrast induced nephropathy, perivalvular leaks
Valvular access site issues: Groin seromas, femoral artery dissection, thrombosis with lower extremity ischemia, retroperitoneal hematoma
Transapical approach: new onset MR, pericardial effusion, pneumothorax, late apical rupture
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
Top contributors: Olivia Sutton, Jessica, Tony Wang, David Leon, William Hsu and Chris Rishel