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首页> 外文期刊>Acta anaesthesiologica Taiwanica : >Transcatheter aortic valve implantation: Anesthetic experience of retrograde transfemoral approach with CoreValve ReValving System
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Transcatheter aortic valve implantation: Anesthetic experience of retrograde transfemoral approach with CoreValve ReValving System

机译：经导管主动脉瓣植入术：CoreValve ReValving System逆行经股动脉入路的麻醉经验

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Objectives: Valvular aortic stenosis (AS) is a major cardiac valvular disease in geriatric people. Conventional treatment for severe AS is aortic valve replacement through surgery. However, many geriatric patients are considered inoperable due to higher risks for surgery and anesthesia. Transcatheter aortic valve implantation (TAVI), a less invasive procedure, has rapidly developed in recent years as an alternative management option for high-risk AS patients. Herein, we describe our anesthetic experience in the TAVI procedure. Methods: We included 11 patients who consecutively received transfemoral TAVI in the period from September 2010 to January 2011. All patients received general anesthesia with endotracheal intubation; arterial line placement and central venous catheter insertion were carried out for monitoring hemodynamics. Transesophageal echocardiography was applied for valve evaluation, hemodynamic monitoring, and intraoperative guidance. Patients were transferred to the intensive care unit for further care after surgery. The periprocedural events were recorded. Results: The mean age of these patients was 82 years. Morphology of the aortic valve in all patients was tricuspid, and the etiology of AS was degenerative calcification. During TAVI, all patients received bolus injections of 5-10 @mg norepinephrine just before the rapid pacing stage in order to increase the mean arterial pressure. Only one patient needed continuous infusion of dopamine because of severe preoperative congestive heart failure, and another patient needed continuous infusion of norepinephrine due to relatively old age and suspected low systemic vascular resistance. After TAVI, all patients had the endotracheal tube extubated within 7 hours, except one because of preoperative ventilator dependence. Another male patient stayed in the intensive care unit for 8 days due to postoperative complete atrioventricular block, and he received permanent pacemaker implantation. There was no early mortality. Conclusion: TAVI is another choice for AS patients who have a high perioperative risk. General anesthesia with endotracheal intubation and application of transesophageal echocardiography can facilitate the use of this new technique by cardiologists. Complete preprocedural evaluation and good intraprocedural cooperation are still the gold standards to achieve successful TAVI and patient safety.
机译：目的：瓣膜主动脉瓣狭窄（AS）是老年人的主要心脏瓣膜疾病。重症AS的常规治疗是通过手术置换主动脉瓣。但是，由于手术和麻醉的风险较高，许多老年患者被认为无法手术。经导管主动脉瓣植入术（TAVI）是一种侵入性较小的手术，近年来已迅速发展成为高危AS患者的替代治疗选择。在此，我们描述了在TAVI手术中的麻醉经验。方法：我们纳入了11例在2010年9月至2011年1月期间连续接受经股TAVI的患者。所有患者均接受了气管内插管全麻;进行动脉管路放置和中心静脉导管插入以监测血液动力学。经食道超声心动图检查用于瓣膜评估，血流动力学监测和术中指导。手术后将患者转移到重症监护室接受进一步护理。记录围手术期事件。结果：这些患者的平均年龄为82岁。所有患者的主动脉瓣形态均为三尖瓣，AS的病因为变性钙化。在TAVI期间，所有患者正好在快速起搏阶段前接受5-10 mg去甲肾上腺素的推注，以增加平均动脉压。由于严重的术前充血性心力衰竭，只有一名患者需要持续输注多巴胺，而另一名患者由于年龄较大且怀疑全身血管阻力低而需要持续输注去甲肾上腺素。 TAVI后，除一名患者由于术前呼吸机依赖性外，所有患者均在7小时内拔出了气管插管。由于术后完全房室传导阻滞，另一名男性患者在重症监护病房停留了8天，并且接受了永久性起搏器植入。没有早期死亡。结论：TAVI是高围手术期AS患者的另一选择。气管内插管全身麻醉和经食管超声心动图检查可以帮助心脏病专家使用这种新技术。完整的术前评估和良好的术中合作仍然是成功实现TAVI和患者安全的金标准。

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