Transcatheter aortic valve replacement

Transcatheter aortic valve replacement

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	In development
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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

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. 

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.

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.

Postoperative 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