Anesthetic management of trans-apical aortic valve implantation
10.12025/j.issn.1008-6358.2017.20160293
- VernacularTitle:经心尖主动脉瓣置入术的麻醉管理
- Author:
Yan HU
1
;
Hong LUO
;
Ke-Fang GUO
Author Information
1. 复旦大学附属中山医院麻醉科
- Keywords:
transcatheter aortic valve implantation;
general anesthesia;
perioperative management
- From:
Chinese Journal of Clinical Medicine
2017;24(1):66-69
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the anesthetic managements during trans-apical aortic valve implantation and the prognosis of patients.Methods:Totally 11 cases undergoing TA-TAVI was enrolled (the average age was 77.91),including 7 cases of aortic stenosis and 4 cases of aortic regurgitation.Hydration treatment was started preoperatively,and strict anesthetic design and careful hemodynamic managements were adopted.After induction the temporary pacemaker wire was placedviathe internal jugular vein.The hemodynamic parameters,extubation time,length of ICU stay and hospitalization days,complications and all-cause mortality before surgery,during surgery and after surgery was recorded and analyzed. Results:The 9 out of 11 patients experienced successful valve implantation procedure,1 patient suffered hepatic and renal dysfunction in 1 week after surgery,and 2 patients suffered hypoxemia,and one of the two died at last.All the complications occurred in patients with aortic stenosis.Compared with baseline,the patients'blood pressure,heart rate (HR),cardiac output (CO),and cardiac index (CI)after induction were significantly reduced until the valve opened (P<0.05).To the end of the surgery,CO and HR reduced below the basic level,and mean arterial pressure (MAP)and CI were still below the basic level.But the hemodynamics fluctuated in an acceptable range,and did not result in any adverse consequences.Conclusions:Even if the anesthesia of TA-TAVI is challenging,strict anesthetic design and careful hemodynamic management can ensure the safety of patients.Also the patients with aortic valve stenosis suffered more complicated surgical procedure and unfavorable prognosis.
