Anesthesia Management of Transapical Transcatheter Aortic Valve Replacement
10.3969/j.issn.1009-6604.2024.10.003
- VernacularTitle:心尖入路经导管主动脉瓣置换术的麻醉管理
- Author:
Ning CHEN
1
;
Yiou WANG
;
Xiaoyu CHEN
;
Yugang DIAO
;
Yingjie SUN
Author Information
1. 北部战区总医院麻醉科,沈阳 110016
- Keywords:
Transapical approach;
Transcatheter aortic valve replacement;
Anesthetic measure
- From:
Chinese Journal of Minimally Invasive Surgery
2024;24(10):666-671
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize the experience of anesthesia management of transapical transcatheter aortic valve replacement(TA-TAVR).Methods Clinical data of 60 cases of TA-TAVR in the Cardiovascular Surgery Department of our hospital from January 2023 to January 2024 were retrospectively analyzed,including 34 cases of aortic stenosis and 26 cases of aortic insufficiency.According to the New York Heart Association(NYHA)functional classification,there were 4 cases of class Ⅱ,11 cases of class Ⅲ,and 45 cases of class Ⅳ.According to the American Society of Anesthesiologists(ASA)classification,there were 12 cases of grade Ⅱ,44 cases of grade Ⅲ,2 cases of grade Ⅳ,and 2 cases of grade V.The European System for Cardiac Operative Risk Evaluation Ⅱ(EuroSCORE Ⅱ)score was 8.3％-54.1％[mean,(20.0±10.3)％].All the patients received general anesthesia with endotracheal intubation.Results Intraoperative ventricular fibrillation occurred in 3 cases.The median mechanical ventilation time of the 60 patients was 17 h(range,0-192 h),including 5 cases of 0 h(extubation in the operating room,which was ultra-fast track anesthesia),17 cases of extubation within 6 h after surgery(fast track anesthesia),31 cases of extubation between 6 and 48 h,and 7 cases of mechanical ventilation time＞48 h.Rescue analgesia after surgery was required in 8 cases.The median ICU stay time was 21 h(range,3-407 h),and the postoperative hospital stay was(7.8±4.5)d.Postoperative complications included 1 case of emergency thoracotomy because of artificial aortic valve dislocation,3 cases of permanent pacemaker implantation because of third-degree atrioventricular block,and 2 cases of tracheal intubation again because of hypoxemia.Conclusion Optimizing the anesthesia intervention measures(anesthesia details,anesthesia monitoring methods,and anesthesia analgesia plan)is helpful for early extubation,achieving ultra-fast track and fast track anesthesia of TA-TAVR.
