Anaes · Cardiac anaesthesia
Anaesthesia for TAVI and structural heart interventions
Also known as TAVR anaesthesia · Transcatheter aortic valve · SOLVE-TAVI sedation · Structural heart cath lab
Exam-pass TAVI anaesthesia: AS haemodynamics, GA vs conscious sedation evidence (SOLVE-TAVI), vascular access crises, haemodynamic collapse, pacing and deployment, and hybrid-lab CRM for ANZCA Final.
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Target exams
Red flags
- Severe AS + vasodilatation/tachycardia can cause spiral collapse.
- Conversion to GA/sternotomy readiness must exist before starting.
- Annular rupture, coronary obstruction, and severe PVL are time-critical crises.
- Vascular access bleeding can be occult under drapes.
- Do not treat pure AS like pure AR with afterload reduction.
Meet the patient
An 82-year-old with severe symptomatic aortic stenosis arrives for transfemoral TAVI. She is frail, on beta-blockers, with a left bundle branch block on her ECG. The cardiologist asks: sedation or general anaesthesia? The question matters, because this is a fixed-obstruction heart that spirals into collapse the moment you vasodilate or tachycardise it.[1]
Two questions frame the whole case: can I protect the three things the stenotic aortic valve needs — preload, sinus rhythm, and afterload? and can I convert to a sternotomy in under five minutes if deployment goes wrong? Hold those two and the rest of the topic is expansion.[1]
References3ShowHide
- [1]Thiele H, Kurz T, Feistritzer HJ, et al. General Versus Local Anesthesia With Conscious Sedation in Transcatheter Aortic Valve Implantation: The Randomized SOLVE-TAVI Trial Circulation, 2020.PMID 32819145
- [2]Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery N Engl J Med, 2010.PMID 20961243
- [3]Mayr NP, Michel J, Bleiziffer S, et al. Sedation or general anesthesia for transcatheter aortic valve implantation (TAVI) J Thorac Dis, 2015.PMID 26543597