Anesthetic Management Of Urgent Transcatheter Aortic Valve Implantation (TAVI)

Proposal Number:

MCC-7130 

Proposal Type:

Medically Challenging Case Report Poster 

Author:

Philipp Peter Granacher  
Hospital Universitario Fundación Jiménez Díaz

Co-Author(s):

Leyre Álvarez Rubio  
Hospital Universitario Fundación Jiménez Díaz
JOSÉ FERNANDO LOPEZ ARIAS  
HOSPITAL UNIVERSITARIO FUNDACIÓN JIMÉNEZ DÍAZ

Abstract:

An 86 year old male patient with history of ischemic cardiopathy, previous PTCA/Stent presented to our emergency department due to cardiogenic syncope. Work-up revealed severe aortic valve stenosis (AS) (transaortic valvular gradient 67mmHg, jet velocity 5m/s), mild left ventricular systolic disfunction (LVEF 40%) and signs of myocardial distress (generalized ST-depression, elevated Troponin-I levels). Coronary angiography confirmed chronic 3 vessel disease, ruling out acute occlusions. The patient was scheduled for transcatheter aortic valve implantation (TAVI). Hospital stay was complicated by a recovered cardiorespiratory arrest due to electromechanical dissociation, episodes of atrial fibrillation and acute pulmonary edema (APE).
Recent studies suggest urgent TAVI as viable treatment strategy for patients with severe AS and APE but lack consensus of ideal anesthetic management. We opted for intraprocedural BiPAP ventilation of the awake patient, perfusion of furosemide, amiodarone and noradrenaline, resulting in clinical and echocardiographic improvement and discharge to home within 5 days without complications.

LEARNING OBJECTIVES: Anesthetic management of urgent TAVI, severe aortic valve stenosis, acute pulmonary edema.

Professional Category:

Resident/Trainee

Keywords:

Cardiothoracic
Other - Endovascular

Enter up to two references.

  Reference
1. The Anesthetic Management of Transcatheter Aortic Valve Implantation. Guarracino F. et al. Seminars in Cardiothoracic and Vascular Anesthesia 2016, Vol. 20(2) 141 –146.
2. Urgent Transcatheter Aortic Valve Implantation in Patients With Severe Aortic Stenosis and Acute Heart Failure: Procedural and 30-Day Outcomes. Landes U. et al. Canadian Journal of Cardiology, 2016 Jun;32(6):726-31.