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
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Provide a brief summary of this surgical procedure and its indications here.

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