scholarly journals Role of monitored anaesthesia care in peri-procedural stroke during unprotected transfemoral aortic valve replacement: A case report

2021 ◽  
Author(s):  
hulya yilmaz ak ◽  
Yasemin Ozsahin ◽  
Kerem Erkalp ◽  
Ziya Salihoglu
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Anaesthesia Care ◽  
Valve Implantation

Abstract: Backgraound: Transcatheter aortic valve implantation (TAVI), with its improved valve technologies will also be an option for patients in the near future and improved operator experience. Cerebrovascular events are among the most feared complications of TAVI, since they cause high morbidity and mortality. Case: After the patient with EuroSCORE II = 8.6% was considered to be at high risk in terms of surgery, the decision to perform TAVI was taken. The valve (Medtronic 26 mm) was successfully placed during the 110 min procedure. Blood loss was 140 mL, no red blood cell (RBC) transfusion and catecholamines requirements were present, no VF (ventricular fibrillation) and cardiac tamponade were observed and post procedure left ventricular ejection fraction (LVEF) was 60%. At the end of the procedure, the BIS value of the patient was 70, regression in the Glasgow Coma Score (GCS = 12), anisocoria in the pupils (R = 2 mm < L = 4 mm) and motor loss in the right arm (3/5) and right leg (3/5) were detected. Modified Rankin scale (mRS) was evaluated as 4. Conclusions: The neurological complication rate of up to 80% during and in the days following the procedure, the long recovery period after embolism, the possibility of being a nursing patient and even the risk of death, remind us that the TAVI procedure and the sedation given during the procedure should never be underestimated. Keywords: Transcatheter aortic valve implantation, cerebral embolism, complications, neuroradiology, monitorized anaesthesia care, aort stenosis.

Aortic Valve Gradient and Clinical Outcome in Patients Undergoing Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis

Cardiology ◽  
2016 ◽  
Vol 134 (2) ◽  
pp. 128-135 ◽  
Author(s):  
Guy Witberg ◽  
Alon Barsheshet ◽  
Abid Assali ◽  
Hana Vaknin-Assa ◽  
Aviv A. Shaul ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Ventricular ◽  
Low Flow ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Objectives: To explore the relation between the baseline aortic valve gradient (AVG) as a continuous variable and clinical outcomes following transcatheter aortic valve implantation (TAVI) in general and specifically in patients with high-gradient aortic stenosis (AS). Methods: We reviewed 317 consecutive patients who underwent TAVI at our institution. We investigated the relation between AVG as a continuous/categorical variable and outcome among all patients and in patients without low-flow low-gradient AS, using the Cox proportional hazard model adjusting for multiple prognostic variables. Results: Patients had a peak AVG of 79.9 ± 22.8 mm Hg (mean 50.5 ±15.7). During a mean follow-up of 2.7 years, AVG was inversely associated with mortality and mortality or cardiac hospitalization. Every 10-mm-Hg increase in peak AVG was associated with 18% reduction in mortality (p = 0.003) and 19% reduction in mortality/cardiac hospitalization (p < 0.001). Every 10-mm-Hg increase in mean AVG was associated with a 24% reduction in both outcomes (p = 0.005 and p < 0.001). Subgroup analysis of patients with left-ventricular ejection fraction >40% or peak AVG >64 mm Hg yielded similar results. Conclusions: Mean and peak baseline AVGs are directly associated with improved outcomes after TAVI; AVG can be used to select the patients most likely to benefit from TAVI.

scholarly journals Az első 200 transzkatéteres aortabillentyű-implantáció a Gottsegen György Országos Kardiológiai Intézetben

2016 ◽  
Vol 157 (45) ◽  
pp. 1786-1792
Author(s):  
Géza Fontos ◽  
Gábor Dékány ◽  
Nikolett Hegedüs ◽  
Zsolt Piróth ◽  
Chaurasia Amit Kumar ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Daily Routine ◽  
Ventricular Ejection Fraction ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
One Year ◽  
Valve Implantation

Introduction: Transcatheter aortic valve implantation is a therapeutic alternative for contraindicated and high surgical risk patients with severe symptomatic aortic stenosis. This intervention is part of daily routine in the Institute of the authors. Aim: In the present work the results of the first 200 patients are discussed. Method: Until January, 2016, 200 patients (female 55%, mean age 79.9 years, average EuroSCORE 19.3%, left ventricular ejection fraction 54%, peak gradient 81.2 mmHg, mean aortic gradient 50.9 mmHg) underwent transcatheter aortic valve implantation. Results: The procedure was performed with 99% success rate. Complications were evaluated according to VARC 2 definitions. Mortality was 5% at one month and 17.4% at one year. Cardiac mortality was 13.6 at one year. Cerebrovascular complications were 5% within one year, and 95% of patients were in NYHA I or II functional classes at one year. Conclusion: These findings are consistent with worldwide results. Orv. Hetil., 2016, 157(45), 1786–1792.

microRNA-206 correlates with left ventricular function after transcatheter aortic valve implantation

2017 ◽  
Vol 313 (6) ◽  
pp. H1261-H1266 ◽  
Author(s):  
J. A. Kleeberger ◽  
J. Neuser ◽  
D. de Gonzalo-Calvo ◽  
T. Kempf ◽  
J. Bauersachs ◽  
...  
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Aortic Valve ◽  
Cardiac Function ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) is the method of choice in patients with high risk or contraindications for conventional aortic valve replacement. However, it is not well understood which parameters predict the overall cardiac function postprocedurally. miRNAs are small noncoding RNA molecules that repress gene expression by different mechanisms and can also be detected in the blood. Recent studies have shown that miRNAs detected in the blood may serve as sensitive and specific biomarkers in various diseases; therefore, we examined the levels of different microRNAs in the serum of patients undergoing TAVI. We thereby intended to find potential predictors for cardiac function after TAVI. Serum from patients with aortic valve disease was obtained at five different points: before the TAVI procedure, at days 1 and 3 after the TAVI procedure, and the day of dischargement and after a period of 3 mo. We next performed quantitative real-time PCRs to examine the samples for changes in the level of miRNAs previously described as cardiac enriched. Our results show that the level of miR-206 in the serum of patients after TAVI correlated negatively with the left ventricular ejection fraction of individual patients. We found left ventricular function to be better in patients with lower levels of miR-206 after implantation of the new valve. A decrease in the serum level of miR-206 may be linked to changes in cardiac function of patients after TAVI. Further studies are necessary to test the miRNA for its potential value as a prognostic marker. NEW & NOTEWORTHY This study is the first to investigate novel miRNA-based biomarkers within the context of transcatheter aortic valve implantation. miRNA-206 proved to correlate inversely with the postprocedural left ventricular ejection fraction of patients.

scholarly journals Sex and Transcatheter Aortic Valve Implantation: Impact of Female Sex on Clinical Outcomes

2019 ◽  
Vol 14 (3) ◽  
pp. 137-141 ◽  
Author(s):  
Alessandra Laricchia ◽  
Barbara Bellini ◽  
Vittorio Romano ◽  
Saud Khawaja ◽  
Matteo Montorfano ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Factors Affecting ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment for severe symptomatic aortic stenosis in patients who are not suitable for surgery or are at high surgical risk. Approximately 50% of patients undergoing TAVI are female and this is reflected by a higher inclusion rate of women in TAVI trials. However, women undergoing TAVI have different baseline clinical characteristics in comparison to men, with fewer comorbidities and a more preserved left ventricular ejection fraction. This translates into favourable outcomes after TAVI, despite a higher rate of peri-procedural complications. This article discusses gender differences in terms of presentation, procedural characteristics and post-procedural results in patients with aortic stenosis undergoing TAVI, with particular focus on possible sex-specific factors affecting outcome.

scholarly journals Assessment of Retinal Capillary Dropout after Transcatheter Aortic Valve Implantation by Optical Coherence Tomography Angiography

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2399
Author(s):  
Jeanne Martine Gunzinger ◽  
Burbuqe Ibrahimi ◽  
Joel Baur ◽  
Maximilian Robert Justus Wiest ◽  
Marco Picirelli ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Optical Coherence Tomography Angiography ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Optical Coherence ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) is an alternative to open heart surgery in the treatment of symptomatic aortic valve stenosis, which is often the treatment of choice in elderly and frail patients. It carries a risk of embolic complications in the whole cerebral vascular bed, which includes the retinal vasculature. The main objective was the evaluation of retinal emboli visible on optical coherence tomography angiography (OCTA) following TAVI. This is a prospective, single center, observational study enrolling consecutive patients over two years. Patients were assessed pre- and post-TAVI. Twenty-eight patients were included in the final analysis, 82.1% were male, median age was 79.5 (range 52–88), median BCVA was 82.5 letters (range 75–93). Eight patients (28.6%) presented new capillary dropout lesions in their post-TAVI OCTA scans. There was no statistically significant change in BCVA. Quantitative analysis of macular or peripapillary OCTA parameters did not show any statistically significant difference in pre- and post-intervention. In conclusion, capillary dropout lesions could frequently be found in patients after TAVI. Quantitative measurements of macular and peripapillary flow remained stable, possibly indicating effective ocular blood flow regulation within the range of left ventricular ejection fraction in our cohort.

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