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HERDIN Record #: 100731-20012303232754 Submitted: 23 January 2020 Modified: 23 January 2020

Anesthetic Considerations and Management for TAVR, Non-Open Heart Aortic Valve Replacement for Severe Aortic Stenosis: A Case report.

Vina Norhaynah  . Lastimosa,
Mellissa Morala-Caranto

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INTRODUCTION: Severe Aortic stenosis, <0.75cm2 (N: 2.5 - 4.5cm2) occurs when the aortic valve narrows preventing it from opening fully obstructing blood flow from left ventricle to aorta towards the systemic circulation traditionally treated with surgical aortic valve replacement (SAVR). However, with the advent of minimally invasive cardiac surgery (MICS) transcatheter aortic valve replacement (TAVR) developed in 1993. This allows an aortic valve be implanted via a catheter inserted mostly at the femoral artery or through small chest incision.
CASE PRESENTATION: A 73y.o 58kg, ASA4, female admitted for exertional dyspnea of increasing severity with easy fatigability and relieved by rest with 2Decho: EF 52%, RVFAC 55%, TAPSE 2.2, AVA 0.62, trivial MR, trivial TR, dilated LA, dilated ascending aorta, and sPAP of 30mmhg, and Coro-Angio: 2VD thus LAD and RCA stenting done. Assessment: Valvular Heart Disease, Severe Calcific Aortic Stenosis, AVA 0.62cm2, mean gradient 46mmHg, Trivial MR, Trivial TR, HCVD, in SR, FC II, S/P PCI; underwent TAVR (Core Valve Evolut R 34mm, Medtronic Minneapolis, USA) with IOTEE and coro-angio with PCI of LAD and RCA without post-procedural complications and was discharged improved.
DISCUSSION: TAVR/TAVI, a rapidly evolving minimally invasive cardiac surgery (MICS) technique for people considered intermediate to high-risk of complications from SAVR, 30-40% in this population. This allows an aortic valve be implanted via a catheter inserted at the femoral artery or through small incision at the chest under either general or local anesthesia with sedation. Precise measurement of the aortic valve annulus via TTE or TEE, multi-slice CT or MRI is the key to success. Complications like vascular injuries: occlusions or embolizations, arrhythmias, renal impairment, stroke, tamponade, and prosthesis malpositioning sometimes may occur.
CONCLUSION: TAVR a new evolving technique of implanting the aortic valve for people who are considered at intermediate to high-risk of complications from SAVR. Challenges on its management is directed to the procedure itself and the population.

Publication Type
Research Report
Date
January 1-December 31, 2019
LocationLocation CodeAvailable FormatAvailability
Philippine Heart Center Medical Library CR.008.19 Fulltext Print Format
 

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