OUR ANESTHETIC EXPERIENCES IN TRANSCATHETER AORTIC VALV IMPLANTATION PROCEDURE

TRANSKATETER AORTİK VALV İMPLANTASYONU İŞLEMİNDE ANESTEZİ DENEYİMLERİMİZ

Abstract

Objective: Transcatheter aortic valve implantation (TAVI) has become a safe alternative to surgical aortic valve replacement in high-risk patients with severe aortic stenosis. The procedure can be performed under general anesthesia or local anesthesia with sedation (LAS). In this study, we aimed to present the patients retrospectively who underwent TAVI treatment with local anesthesia plus sedation in our hospital. Method: A total of 32 patients underwent TAVI treatment with LAS between March 2016 and March 2018 were retrospectively investigated in our hospital. Demographic data, preoperative risk scoring, intraoperative anesthesia management, complications and postoperative first 30 day mortality rates were evaluated. Results: TAVI procedure was applied to a total of 32 patients including 31 patients with LAS and 1 patient under general anesthesia (GA). The EuroSCORE average of the patients was 7.87±2.33 and the STS (Society of Thoracic Surgeons) risk score was 11.59±2.36. The mean duration of the procedure was 87.34±25.58 min and the duration of the anesthesia was 98.43±25.69 min. The most frequent intraoperative complication was hypotension (34.3%) and inotropic support was used in these patients. The most preferred anesthetic agent was propofol (90.6%) and during the procedure it was found that the patients were mostly sleepy, but at a level that could respond to verbal stimuli (78.1%). 30-day mortality rate was 12.5%. Conclusion: It has been observed that transfemoral TAVI procedures can be safely performed in selected patients with local anesthesia and sedation. Open heart surgery preparation, including general anesthesia equipment, is required and should be available at the beginning of the procedure and should be warned against intraoperative hypotension, bradycardia and severe arrhythmia.

Özet

Amaç: Yüksek cerrahi risk tafl›yan ciddi aort stenozlu hastalarda, transkateter aortik valv implantasyonu (TAV‹) ifllemi cerrahi kapak replasman›na güvenli bir alternatif olarak uygulanmaktad›r. Transkatater aortik valv implantasyonu (TAV‹) hem genel anestezi hem de lokal anestezi ve sedasyon eflli¤inde uygulanabilmektedir. Çal›flmada hastanemizde TAV‹ uygulamas› s›ras›nda kullan›lan anestezi yöntemlerini retrospektif olarak araflt›rmay› planlad›k. Yöntem: Hastanemizde Mart 2016-Mart 2018 tarihleri aras›nda TAV‹ uygulanan toplam 32 hasta retrospektif olarak araflt›r›ld›. Hastalar›n demografik verileri, preoperatif risk skorlamalar›, intraoperatif anestezi yönetimi ve kullan›lan anestezik ajanlar, geliflen komplikasyonlar ile postoperatif ilk 30 günlük mortalite oranlar› de¤erlendirildi. Bulgular: 31 hasta lokal anestezi ve sedasyon ile, bir hasta ise entübe edilerek genel anestezi (GA) alt›nda olmak üzere toplam 32 hastaya TAV‹ ifllemi yap›ld›. Hastalar›n EuroSCORE ortalamas› 7.87±2.33 olup, STS (Society of Thoracic Surgeons) risk skor ortalamas› 11.59±2.36 idi. ‹fllem süresi ortalama 87.34±25.58 dk, anestezi süresi ise 98.43±25.69 dk olarak saptand›. ‹ntraoperatif en s›k görülen komplikasyon hipotansiyon (%34.3) olup inotrop-vazopressör deste¤i sa¤land›. Hastalara ifllem süresince uygulanan sedasyonun ço¤unlukla sesli uyarana yan›t verecek düzeyde (Ramsay sedasyon skoru:3) oldu¤u gözlendi (%78.1). En s›k tercih edilen anestezik ajan propofol olarak saptand› (%90.6). 30 günlük mortalite oran› %15 olarak belirlendi. Sonuç: TAV‹ ifllemlerinin seçilmifl hastalarda lokal anestezi ve sedasyon eflli¤inde güvenle uygulanabildi¤i gözlenmifltir. ‹fllem öncesinde genel anestezi ekipmanlar› ve aç›k kalp cerrahisi haz›rl›¤› gerekmekte olup intraoperatif geliflebilecek hipotansiyon, bradikardi ve ciddi aritmiler bak›m›ndan tedbirli olunmal›d›r.