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Candela et al. Vessel Plus 2018;2:28 Vessel Plus
DOI: 10.20517/2574-1209.2018.31

Review Open Access

Transcatheter aortic valve replacement: is
anesthesiologic management linked to surgical
outcomes?

Chiara Candela, Annalaura Di Pumpo, Alessandro Centonze, Fabrizio Cucciniello, Domenico Sarubbi,
Felice Eugenio Agrò

Department of Anesthesiology, Università Campus Bio-Medico di Roma, Rome 00128, Italy.

Correspondence to: Dr. Chiara Candela, Department of Anesthesiology, Università Campus Bio-Medico di Roma, Rome 00128,
Italy. E-mail: c.candela@unicampus.it
How to cite this article: Candela C, Di Pumpo A, Centonze A, Cucciniello F, Sarubbi D, Agrò FE. Transcatheter aortic valve
replacement: is anesthesiologic management linked to surgical outcomes? Vessel Plus 2018;2:28.
http://dx.doi.org/10.20517/2574-1209.2018.31

Received: 14 May 2018 First Decision: 25 Jul 2018 Revised: 7 Sep 2018 Accepted: 7 Sep 2018 Published: 29 Sep 2018
Science Editors: Mario F. L. Gaudino, Cristiano Spadaccio Copy Editor: Yuan-Li Wang Production Editor: Zhong-Yu Guo

Abstract
Aortic valve replacement (AVR) is the current standard treatment for severe aortic stenosis, nonetheless, many patients
are not suitable to AVR because of high risk related to advanced age, impaired cardiac function, or comorbidities. Given
these considerations, transcatheter aortic valve replacement or implantation (TAVR or TAVI) has emerged in the last
decade as an alternative to surgery and has become the treatment of choice for severe aortic stenosis in patients with
prohibitive surgical risk. In the context of this kind of hybrid procedure, the anesthesiologist plays a central role because
the choice of anesthetic technique is strongly related to clinical features of the patients and technical considerations,
which must be discussed collegially with the surgeons. The choice of anesthesiologic management is different among
hospitals, but it is generally based on preoperative comorbidities, procedural approach used for TAVR and even hospital
logistic. Some centers used to perform TAVR under general anesthesia (GA), some else under local anesthesia plus
sedation (LAS), some of them start their TAVR program under GA, but convert in LAS when the team get enough
experience. Also, anesthesiologists involved in TAVR procedures must be part of a “heart team”, and should be confident
with anesthesia for cardiovascular surgery, mechanical circulatory support, and with transesophageal echocardiography.
The aim of this article is to provide a general overview about anesthetic techniques in TAVR and to evaluate pathways
for future researches.

Keywords: Transcatheter aortic valve implantation, anesthesia, aortic valve disease

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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