Anesthetic Implications of Percutaneous Valve Procedures (pp. 77-112)
Authors: (Andrej Alfirevic, David G Anthony, Krishna R Mudimbi)
Abstract: Valvular heart disease represents a growing public health problem correlating with the increase in older age population. Periprocedural as well as long term morbidity and mortality after conventional surgical procedures are still significant in high risk surgical candidates. In addition, a good percentage of patients do not get operated on because of the presence of patients‘ co-morbidities, old age and other factors. Advances in technology enabled evolution of different percutaneous minimally invasive procedures reserved to decrease the risk of perioperative morbidity and mortality from conventional surgical procedures.
The anesthetic management of percutaneous valve procedures involves non-traditional operating room settings including remote locations with confined space as well as exposure to radiation and requires detailed knowledge of sequence of events pertained to the specific technique and potential complications associated with it. Anesthesiologists are involved in the preoperative, intraoperative and postoperative care of these patients. Meticulous preparedness and communication between all members of the team is crucial for the success.
Newer techniques such as aortic and mitral valve trans-catheter procedures are becoming alternative treatment options to wide variety of patients while techniques such as balloon valvuloplasties are trying to redefine their positions. Percutaneous approach to paravalvular regurgitation is also becoming an interesting minimally invasive alternative technique avoiding complications of conventional re-operation surgery. Percutaneous procedures are performed in the catheterization lab or hybrid operating rooms under the guidance of fluoroscopic angiography as well as trans-esophageal echocardiography both requiring management expertise from the involved anesthesiologist.