الفهرس | Only 14 pages are availabe for public view |
Abstract Background: Aortic valve diseases are the most common debilitating valvular heart lesions in adults. Surgical aortic valve replacement is the treatment of choice for the vast majority of patients, but up to 30–40% of the patients are considered as having too high risk for surgery and, hence, remain unreferred and untreated. Prognosis with medical management is poor, and effects of percutaneous balloon aortic valvuloplasty are modest and short lived. Aims: The aim of this work is to focus the light on the anesthetic techniques used for Transcatheter Aortic Valve Implantation, to illustrate some of the surgical approaches and techniques that are commonly used, and to discuss the choice of general anesthesia versus conscious sedation, also to discuss the role of transesophageal echocardiography during the procedure. Conclusion: The main issue regarding anesthetic management during TAVI is hemodynamic stability. Anesthesiologists should provide less-invasive anesthesia/analgesia without compromising the safety or comfort of the patient. Local anesthesia plus sedation is a reliable alternative to general anesthesia. Goals of hemodynamic management are those typical of aortic stenosis. TEE has an important role during TAVI procedure , which includes assessment of the anatomy of the aortic annulus and ascending aorta, sizing the aortic annulus, and identification of the intracardiac catheters, the valvuloplasty balloon, the valve, and the catheter tip. Also post deployment, TEE helps in detection of aortic valve regurgitation, valve embolization, valve malposition and mitral valve regurgitation |