RESUMO
El implante de la válvula aórtica transcatéter es una alternativa al tratamiento de pacientes con estenosis aórtica severa, se realiza convencionalmente en anestesia general o anestesia local más sedación. Presentamos el primer caso de implante valvular aórtico transcatéter por vía transfemoral realizado en nuestro hospital en un paciente con estenosis aórtica severa con riesgo quirúrgico alto. La anestesia consistió en la combinación de bloqueo bilateral selectivo de los nervios iliohipogástrico, ilioinguinal y genitofemoral con el paciente despierto sin sedación, mediante el abordaje guiado por ecografía. El implante valvular aórtico transcatéter fue exitoso y transcurrió sin incidencias, el paciente se mantuvo inmóvil, tranquilo, no refirió dolor y no fue necesario suministrar sedantes/hipnóticos durante la dilatación de los accesos vasculares con los introductores. La monitorización estándar mostró estabilidad hemodinámica sin repercusión cardiovascular y no requirió apoyo de fármacos vasopresores o inotropos. Tras la intervención el paciente fue enviado a la Unidad de Cuidados Intensivos Cardiológicos, donde se mantuvo asintomático y estable. Posteriormente el paciente ingresó en la sala de cardiología de la que fue dado de alta sin complicaciones.(AU)
Transcatheter aortic valve implantation is an alternative treatment for patients with severe aortic stenosis, it is conventionally performed under general anaesthesia or local anaesthesia plus sedation. We present the first case of trans-femoral, trans-catheter aortic valve implantation, performed in our hospital in a patient with severe aortic stenosis, who was a high surgical risk. Anaesthesia consisted of a combination of bilateral selective blockade of the iliohypogastric, ilioinguinal and genitofemoral nerves with the patient awake without sedation, using an ultrasound-guided approach. Transcatheter aortic valve implantation was successful and passed without incident, the patient remained immobile, calm, did not report pain, and sedation or hypnotics were not necessary during dilation of the vascular accesses with the introducer. Standard monitoring demonstrated haemodynamic stability, without cardiovascular repercussions and did not necessitate vasopressor or inotropic drug support. After the intervention, the patient was sent to the Cardiac Intensive Care Unit, where he remained asymptomatic and stable. Subsequently, the patient was admitted to the cardiology ward from where he was discharged without complications.(AU)
Assuntos
Humanos , Masculino , Idoso , Plexo Lombossacral , Substituição da Valva Aórtica Transcateter , Anestesia Geral , Estenose da Valva Aórtica , Anestesiologia , Pacientes Internados , Exame FísicoRESUMO
Transcatheter aortic valve implantation is an alternative treatment for patients with severe aortic stenosis, it is conventionally performed under general anaesthesia or local anaesthesia plus sedation. We present the first case of trans-femoral, trans-catheter aortic valve implantation, performed in our hospital in a patient with severe aortic stenosis, who was a high surgical risk. Anaesthesia consisted of a combination of bilateral selective blockade of the iliohypogastric, ilioinguinal and genitofemoral nerves with the patient awake without sedation, using an ultrasound-guided approach. Transcatheter aortic valve implantation was successful and passed without incident, the patient remained immobile, calm, did not report pain, and sedation or hypnotics were not necessary during dilation of the vascular accesses with the introducer. Standard monitoring demonstrated haemodynamic stability, without cardiovascular repercussions and did not necessitate vasopressor or inotropic drug support. After the intervention, the patient was sent to the Cardiac Intensive Care Unit, where he remained asymptomatic and stable. Subsequently, the patient was admitted to the cardiology ward from where he was discharged without complications.
Assuntos
Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Substituição da Valva Aórtica Transcateter , Masculino , Humanos , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Plexo LombossacralRESUMO
El implante valvular aórtico transcatéter, es un procedimiento cardiovascular de mínima invasión y una alternativa frente a la intervención convencional, en insuficiencia aórtica severa. En este trabajo se realiza una revisión de las complicaciones y la sobrevida, en pacientes sometidos a TAVI, frente a remplazo aórtico tradicional. Para ello se realizó una investigación documental con información entre los años 2010-2018. El implante valvular aórtico transcatéter debe efectuarse vía transfemoral o transapical, con una válvula Core o Sapien XT, según la necesidad del individuo, para evitar la regurgitación para valvular. Con este implante disminuyen las complicaciones y se remodela el ventrículo izquierdo; reduciendo la disnea y mejorando el pronóstico vida y la tasa de mortalidad en comparación con otros métodos(AU)
The transcatheter aortic valve implant is a minimally invasive cardiovascular procedure and, an alternative to conventional intervention in severe aortic insufficiency. In this work, a review of complications and survival is performed in patients undergoing TAVI, compared to traditional aortic replacement. For this, a documentary investigation was carried out with information between the years 2010-2018. The transcatheter aortic valve implant should be performed transfemorally or transapically, with a Core or Sapien XT valve, depending on the individual's need, to avoid regurgitation to valvulate. With this implant the complications decrease and the left ventricle is remodeled; reducing breathlessness and improving the life prognosis and mortality rate compared to other methods(AU)
Assuntos
Humanos , Insuficiência da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Radiografia Torácica/métodos , Substituição da Valva Aórtica Transcateter/métodos , Liberação de Cirurgia , Angiografia/métodos , Cateterismo Cardíaco , Taxa de Sobrevida , Estudos RetrospectivosRESUMO
Aortic stenosis (AS) is the most frequent valve disease in the elderly population Treatment is valve replacement either by open surgery, or in the case of patients at high surgical risk, by TAVI (Transcatheter Aortic Valve Implantation). However, almost 40% of patients who have undergone TAVI show poor health outcomes, either due to death or because their clinical status does not improved. This review examines the non-cardiac aspects of patients with AS, which may help answer three key questions in order to evaluate this condition pre-surgically: 1) Are the symptoms presented by the patient exclusively explained by the AS, or are there other factors or comorbidities that could justify or increase them?, 2) What possibilities for improvement of health status and quality of life has the patient after the valve replacement?, and 3) How can we reduce the risk of a futile valve replacement?
