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首页> 外文期刊>Current opinion in anaesthesiology >Anesthetic management of transcatheter aortic valve implantation.
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Anesthetic management of transcatheter aortic valve implantation.

机译：经导管主动脉瓣植入的麻醉管理。

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PURPOSE OF REVIEW: The revolution in transcatheter aortic valve implantation (TAVI) for the treatment of aortic stenosis has been well described by the large number of randomized trials, registries, and single and multicenter experiences published during 2010-2011. The aim of this review is to describe the challenges of the anesthetic management related to TAVI. RECENT FINDINGS: Recent data show that TAVI is clinically effective in patients with inoperable aortic stenosis when compared with standard therapy. It can be accomplished in high-risk patients with favorable outcomes compared with surgery as predicted by standard estimates of mortality and is associated with functional and hemodynamic improvement. Currently, TAVI is targeted at high-risk patients, but may be extended to lower risk groups in the near future. Outstanding questions concerning TAVI are related to its long-term durability and to procedural complications. SUMMARY: Preprocedural, multidisciplinary assessment of the patient is essential prior to TAVI and should include a full anesthetic evaluation, consideration of patient comorbidities, and determination of technical feasibility. The role of scoring systems for risk prediction requires further scrutiny. Multidevice/multiple access approaches allow for treatment of a wide range of patients. Anesthetic techniques and supportive measures vary depending on procedural concerns, patient comorbidity, and severe, often unstable cardiac disease. Echocardiography is fundamental to preoperative evaluation, procedure guidance, and assessment of complications. Planned bailout strategies should be discussed with all members of the medical team. Postoperative standardized monitoring and management protocols are essential.
机译：审查目的：2010年至2011年期间发表的大量随机试验，登记册以及单中心和多中心经验已很好地描述了经导管主动脉瓣膜植入术（TAVI）的治疗。这篇综述的目的是描述与TAVI相关的麻醉管理的挑战。最近的发现：最新数据显示，与标准疗法相比，TAVI在无法手术的主动脉瓣狭窄患者中有效。与标准的死亡率估计值所预测的相比，与手术相比，高风险患者可以实现良好的结局，并且可以改善功能和血液动力学。目前，TAVI主要针对高危患者，但在不久的将来可能会扩展到低危人群。有关TAVI的悬而未决的问题与它的长期耐用性和程序并发症有关。摘要：在进行TAVI之前，对患者进行术前，多学科评估是至关重要的，并且应包括全面的麻醉评估，对患者合并症的考虑以及技术可行性的确定。评分系统在风险预测中的作用需要进一步审查。多设备/多通路方法允许治疗广泛的患者。麻醉技术和支持措施因手术问题，患者合并症以及严重的，经常不稳定的心脏病而异。超声心动图是术前评估，程序指导和并发症评估的基础。应与医疗团队的所有成员讨论计划的救助策略。术后标准化监测和管理方案至关重要。

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