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Post by Soo-Ok Kim on Jul 29, 2017 19:31:58 GMT -5
Potential complications for TAVR during RVP are hypotension, sustained vtach or vfib. Other complications with this procedure include heart block, vascular injury, coronary artery occlusion, cardiac tamponade, and AKI. My preference for anesthesia will be depending on various factors: patients' preference, the experience level of interventional cardiologist, and the availabilty of institutional resources (like cardiac surgeon). I also would like to add the comfort level of the anesthesia attending who I work with. It can be either MAC or GA. In fact, Iknow someone who had this procedure done under MAC. As the article mentioned, this procedure, for now, is aimed for high risk patients, so patients' cormobidity is already complexed. No matter what kind of anesthesia plan is, constant vigilant care will be must. Thank you for this good article.
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Post by Wai-Ling Lo on Jul 30, 2017 19:55:53 GMT -5
Thank you everyone for reading the article and sharing your thoughts. I would like to answer some of the questions from the above before this discussion end: Yes, we do TAVR cases up on 5th floor. These cases are usually assigned to residents or fellow but we get to do these occasionally. As a matter of fact, Heather is scheduled to do 3 TAVR cases on the coming Monday. Hooray! As for TAVR, Dr. Brady mentioned that it was initially done under GA due to all the concerns that u all mentioned. Moreover, all parties involved were new to the procedure. However, after gaining more experience and now they mainly do these cases under sedation but are ready to convert to GA at any time (just like what Carla said). That being said, the anesthesia plan for each case must be decided on after a careful preop evaluation, considering the risk/benefit and patient cooperation and plan accordingly (just like what Belinda, Ben, Augustine, Dahlia... said ). Another note about rapid ventricular pacing: There are two main type of valve being used, balloon-expandable Edwards SAPIEN XT valve and the self-expanding Medtronic CoreValve. Balloon expandable valves require rapid ventricular pacing (180-220 beats per minute [bpm]) for deployment to reduce cardiac output and avoid inaccurate valve implantation. Other devices may not routinely require ventricular pacing, although this may still be useful in instances when valve positioning is challenging (e.g., horizontal aorta).
The melody pulmonary valve replacement mentioned by Belinda is for RVOT obstructions or lesions. It can be done GA or deep sedation, it really depends on each individual case's condition too.
Great discussion! Thank you all!
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Post by krechti1 on Jul 31, 2017 14:50:39 GMT -5
1) Possible complications include sustained V-tach or v-fib, especially with decreased LV function; vascular injury, retroperitoneal hemorrhage, and cardiac tamponade. 2) According to a study quoted in the article, 17% of about 3500 MAC cases had to be converted to GA, mostly due to vascular complications. With this in mind, in choosing the anesthetic, careful attention must be paid to the severity of preexisting vascular disease. These patients may be a better candidate for GA. If doing MAC, must be ready to quickly convert to GA if complications arise.
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Kristen Praesel Lang
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Post by Kristen Praesel Lang on Jul 31, 2017 16:59:32 GMT -5
Potential complications for TAVR during rapid ventricular pacing include hypotension and arrhythmias. I would choose GA for this case. Great article Wai-ling! Thanks for sharing!
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