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British Journal of Anaesthesia 2009 103(6):792-799; doi:10.1093/bja/aep311
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 BJA: December 2009
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© The Author [2009]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Transcatheter aortic valve insertion: anaesthetic implications of emerging new technology

A. A. Klein1,*, S. T. Webb1, S. Tsui2, C. Sudarshan2, L. Shapiro3 and C. Densem3

1 Department of Anaesthesia and Intensive Care,
2 Department of Cardiothoracic Surgery and
3 Department of Cardiology, Papworth Hospital, Papworth Everard, Cambridge CB23 3RE, UK

* Corresponding author. E-mail: andrew.klein{at}papworth.nhs.uk

Transcatheter aortic valve insertion is a new development that potentially offers a number of advantages to patients and healthcare providers. These include the avoidance of sternotomy and cardiopulmonary bypass, and much faster discharge from hospital and return to functional status. The procedure itself however is quite complex, and presents significant demands in planning and implementation to the multidisciplinary team. Anaesthetic input is essential, and patient care in the perioperative period can be challenging. Early results have shown a significant mortality and morbidity rate, but the majority of procedures to date have been carried out in elderly patients with multiple comorbidities, making comparison with surgical aortic valve replacement inappropriate. Long-term outcomes are not yet known, but randomized controlled trials should allow this procedure and its application to be properly assessed.

Keywords: anaesthesia, general; complications, aortic valve disease; heart, catheterization; surgery, cardiovascular


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