Original articleAnesthetic Management of Transcatheter Aortic Valve Implantation With Transaxillary Approach
Section snippets
Methods
After ethical committee approval and patients' written consent, the authors prospectively collected data of patients with severe symptomatic AS undergoing transaxillary TAVI from March 2009 to October 2009 in 2 teaching hospitals. Most of the patients had severe symptomatic AS. In selected cases, TAVI was proposed for the treatment of pure or predominant aortic regurgitation and dysfunctional aortic bioprosthesis.
Patients were evaluated by a team of cardiologists, cardiac surgeons, and
Results
Between March 2009 and October 2009, 108 patients underwent TAVI at the authors' institution. In 22 patients (20.3%), the procedure was performed via the transaxillary approach. All patients presented high risk for surgery and nonpermissive iliac-femoral arteries, which contraindicated the transfemoral approach. Preoperative characteristics are reported in Table 1. Twenty patients suffered from severe AS, 1 patient presented a dysfunctional aortic bioprosthesis, and another one had severe
Discussion
TAVI currently is emerging as an alternative therapy for patients with severe aortic stenosis at high risk for conventional surgery.5 The transfemoral retrograde approach is feasible in the majority of patients, with high success rates.5, 6, 7 Alternatively, a transaxillary approach can be used in patients with small or diseased iliofemoral arterial systems. The aim of this study was to describe, from the point of view of anesthesia and intensive care specialists, the perioperative management
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